Traffic Injury Prevention

Objective: The consequences of road crashes are various, and few studies have dealt with the multidimensionality of outcomes. The aim of the present study was to assess the multidimensional nature of outcomes one year after a crash and to determine predictive factors that could help in adapting medical and social care to prevent such consequences to improve road crash victims' prognosis. Methods: The study population was the 886 respondents to the one-year follow-up from the ESPARR (Etude et Suivi d'une Population d'Accidentés de la Route du Rhône) cohort, aged ≥ 16 years; the analysis was carried out only on the 616 subjects who fully completed a self-report questionnaire on health, social, emotional, and financial status one year after a crash. Multiple correspondence analysis and hierarchical clustering was implemented to produce homogeneous groups according to differences in outcome. Groups were compared using the World Health Organization Quality of Life Assessment (WHOQOL-BREF, a standard instrument of quality of life, assessing physical health, psychological health, social relationships, and environment) and the Injury Impairment Scale (IIS), a tool to predict road crash sequelae. Baseline predictive factors for group attribution were analyzed by weighted multinomial logistic regression models. Results: Three hundred seventeen of the 616 subjects (60.1%) were men. Mean age was 36.9 years (SD = 16.5). Five victim groups were identified in terms of consequences at one year: one group (206 subjects, 33.4%) with few problems, one with essentially physical sequelae, one with problems that were essentially both physical and social, and 2 groups with a wider range of problems (one including psychological problems but fewer environmental problems; the last one reported negative physical, psychological, social, and environmental impact; notably, all had post-concussion syndrome [PCS]). There were significant differences between groups in terms of family status, injury severity, and certain types of injury (thorax, spine, lower limbs). Comparison on the WHOQOL-BREF confirmed that groups reporting more adverse outcomes had a lower quality of life. Description of the 5 groups by IIS indicators showed that IIS underestimated physical consequences one year after the crash. In addition to the known prognostic factors such as age, initial injury severity, and injury type, socioeconomic fragility and having a relative involved in the accident emerged as predictive of poor outcome at one year. Conclusions: One year after the crash, victims may still be experiencing multiple problems in terms of not only physical health but also of mental health, social life, and environment. Poor outcome may be predicted from both accident-related factors and socioeconomic fragility. Our results are useful in catching the attention of both clinicians and the public administration regarding victims at risk of suffering from important consequences after an accident. If those suffering head injuries are recognized, it would be very important to better consider and treat posttraumatic stress disorder (PTSD) or PCS. Furthermore, subjects from lower socioeconomic backgrounds, with or without lower limb injuries, have numerous difficulties after an accident, notably for returning to work. An objective would be to provide them with more specific support. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

UR-144 [(1-pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)-methanone] is a synthetic cannabinoid, which has been detected in many 'legal highs' seized from the global drug market since the beginning of 2012. It gained popularity as a 'legal' alternative to classic cannabis in countries where it was not controlled. The popularity of UR-144 means that this substance is also abused by individuals driving motor vehicles. This paper describes a case of driving under the influence (DUI) of UR-144. The aim of the undertaken case analysis and presenting description of pharmacological similarity of THC and UR-144 is to answer the question whether UR-144 can produce effects incompatible with safe driving. Blood from the driver was obtained by a physician approximately 2 h after the collision and 4.5 h after self-reported dosing. Police from the crash site provided behavioral observations, and the physician performed medical examination. Blood was analysed by liquid chromatography - tandem mass spectrometry (LC-MS/MS). The developed method was described in detail. The method was linear in the range of 0.5 - 50 ng/mL; the precision and accuracy values obtained were less than 15%. The symptoms observed by police and physician who collected the blood sample were described. In the blood sample collected from the driver UR-144 and its major pyrolysis product [1-(1-pentyl-1H-indol-3-yl)-3-methyl-2-(propan-2-yl)but-3-en-1-one] were detected. Whole blood concentration of UR-144 was 14.6 ng/mL. The result of blood analysis and observed symptoms clearly indicated that the driver was under the influence of UR-144. UR-144 produces effects and impairment similar or even more dangerous to delta-9-tetrahydrocannabinol (Δ(9)-THC), making it unsafe for driving. , , Therefore, UR-144 should be treated as a potentially dangerous substance in traffic safety.

The objective of this study was to provide a contemporary analysis of the alcohol-impaired driving problem among 16- to 17-year-olds and to consider the potential role of night and passenger restrictions in dealing with the alcohol problem by determining how many of the alcohol-related crashes take place at night or with passengers. The data were derived from the Fatality Analysis Reporting System for 16- to 17-year-old passenger vehicle drivers in fatal crashes during 2005-2009. During the 5-year period, 15 percent of the 8664 16- to 17-year-old drivers in fatal crashes had positive blood alcohol concentrations, most of which were 0.08 percent or greater. Drivers in alcohol-related crashes were more likely than those in non-alcohol-related crashes to be male, unbelted, in single vehicles, and speeding, and their crashes were more likely to occur on Saturday or Sunday, at night, and when passengers were present. Of the alcohol-related crashes, 88 percent took place at night or with passengers present or both, as did 67 percent of the non-alcohol-related crashes. Stronger night and passenger restrictions with increased compliance and greater application of alcohol-specific policies would likely be effective in reducing the alcohol-related and non-alcohol-related crashes of 16- to 17-year-olds. Increasing the licensing age beyond age 16 would supplement the effectiveness of these actions.

To mitigate the high risk of motor vehicle crashes for young beginning drivers, over 40 states and the District of Columbia have implemented graduated driver licensing (GDL) systems that gradually and systematically ease teen drivers into higher risk driving conditions. Evaluations of GDL programs using motor vehicle crash data have demonstrated marked declines in crashes. The objective of this study is to examine the association between the implementation of the North Carolina GDL program and the rate of hospitalization, as well as hospital charges, for 16-and 17-year-old drivers. Data were obtained from the North Carolina Hospital Discharge Database for the 26 months before and 46 months after the December 1, 1997, implementation of the GDL program. ARIMA interrupted time series analyses were used to model monthly hospitalization rates, controlling for the hospitalization rates of 25-to 54-year-old drivers. ARIMA analyses were also used to determine whether changes occurred in monthly total hospital charges. Among the 568 16-year-old hospitalized drivers, GDL was associated with a 36.5% decline in the hospitalization rate per population and a 31.2% decline in the total monthly driver hospitalization charges. Although a 12% reduction in the rate of hospitalizations was observed among the 615 17-year-old drivers, the analysis lacked sufficient power to be statistically reliable. No consistent change was observed in the 16-year-old driver total monthly hospital charges. The North Carolina GDL program was associated with a marked decline in the rate of hospitalizations and hospital charges for 16-year-old drivers. Following the implementation of GDL, over $650,000 in hospital charges have been averted each year for 16-year-old drivers. Analyses suggest these reductions were primarily the result of reduced exposure rather than an improvement in teen driving.

To develop a better understanding of the frequency and characteristics of teenage driver crashes occurring during school commute times. Data were obtained from police reports of crashes involving drivers ages 16-17 that occurred between September 2001 and August 2004 in Fairfax County, Virginia. Temporal patterns and other characteristics of crash involvement during the school year were examined, and crashes during school commute times were compared with those at other times. Teenage driver crash involvement spiked during weekday school commute times. Compared with other times, crashes during school commute times were significantly more likely to involve multiple vehicles but less likely to result in injuries or involve drivers who were male, made driving errors, or had been drinking alcohol. Crashes during school commute times were more likely to involve more than one teenage driver and occur close to schools. Crashes involving teenage drivers are prevalent during school commute times. Many of these crashes involve multiple teenage drivers and occur near schools. Schools and communities should consider programs and policies that reduce teenage driving to school and enhance the safety of teenagers that do drive.

Though there is ample research indicating that nighttime, teen passengers, and speeding increase the risk of crash involvement, there is little research about teen drivers' exposure to these known risk factors. Three research questions were assessed in this article: (1) Does exposure to known risk factors change over time? (2) Do teenage drivers experience higher rates of exposure to known risk factors than adult drivers? (3) Do teenage drivers who own a vehicle experience higher rates of exposure to risk factors than those who share a family vehicle? Forty-one newly licensed teenage drivers and at least one parent (adult) were recruited at licensure. Driving data were recorded for 18 months. Average vehicle miles traveled (VMT) or average nighttime VMT for teens did not increase over time. Teenagers consistently drove 24 percent of VMT at night, compared with 18 percent for adults. Teenagers drove 62 percent of VMT with no passengers, 29 percent of VMT with one passenger, and less than 10 percent of VMT with multiple passengers. Driving with no passengers increased with driving experience for these teens. Teenage drivers who owned their vehicles, relative to those who shared a vehicle, sped 4 times more frequently overall and more frequently at night and with multiple teen passengers. These findings are among the first objective data documenting the nature of teenage driving exposure to known risk factors. The findings provide evidence that vehicle access is related to risk and suggest the potential safety benefit of parental management of novice teenage driving exposure.

The objective of this article was to explore trends in licensing among babyboomer older drivers in the state of Victoria, Australia. The study aims were to (1) compare the car licensing trends of the babyboomer cohort to that of previous birth cohorts and (2) predict the number of babyboomers licensed to drive a car in 2021 when the babyboomer cohort reaches an average age of 65 years. The residential population of Victoria, Australia, for 2001-2013 was obtained from the Australian Bureau of Statistics; car licensing statistics were obtained from VicRoads. Birth cohorts from 1916 to 1975 were defined in 10-year birth-year intervals. Population size was modeled using logistic regression. License prevalence was modeled using a logit model. The babyboomer cohort (1946-1965) in Victoria is 1.7 times larger than the cohort before them. At age 60 years, license prevalence among babyboomers was higher than in previous cohorts: 88% in the 1936-1945 cohort vs. 96% in the 1946-1955 cohort. When the babyboomers reach 65 years (average) in 2021, we estimate there to be over twice as many license holders among them than in the preceding cohort (n = 1,300,094 vs. 630,830, respectively). Aging of the babyboomer cohort will have a greater impact on the driving population than on the general population, due to the multiplicative effect of cohort size and license prevalence. The impact of road user aging on burden of injury can be minimized by focusing prevention at crashes typical to older drivers, such as intersection crashes, and promoting car safety features among older drivers.

Road traffic injuries (RTIs) have become the leading cause of injury deaths in China. This article analyzed the trends in all crashes, nonfatal injuries, and fatalities from road traffic crashes from 1951 to 2008 and compared the crash frequency, crash severity, and crash patterns by provinces, types of road, and injured road users. Road traffic crash data were obtained from the Bureau of Traffic Management at the Ministry of Public Security and National Bureau of Statistics of China. Descriptive statistical analyses were conducted. Over the past 5 decades, road traffic injuries have increased substantially in China. From 1951 to 2008, the total number of road traffic crashes, nonfatal injuries, and fatalities increased by 43-fold, 58-fold, and 85-fold, respectively. Linear regression suggested a significant decline of 30.1 percent (95% confidence interval [CI]: 24.8-35.3) in the mortality rate per 100,000 people during the period 2002 to 2008. From 2004 to 2008, road traffic crash mortality rate per 100,000 people varied greatly in China from the lowest of 3.0 in Henan in 2008 to the highest of 21.7 in Xizang in 2004. RTIs in China disproportionally affected the following populations: males, persons 21 to 50 years of age, pedestrians, and motorcyclists/bicyclists. Adults aged more than 65 years accounted for approximately 10 percent of total road traffic deaths. Road types and RTIs severity were closely related; highways were associated with greater mortality rates. Road traffic injuries have become a burgeoning public health problem in China. Programs need to be developed to prevent nonfatal injuries and fatalities caused by road traffic crashes in this emerging country.

This article presents a time-series analysis of changes in road safety in the United States from a public-health point of view. A 50-year period was examined, from 1958 to 2008. The emphasis was on the changes by decades in fatalities per population across different age groups. First, from 1958 to 2008, the overall fatality rate per population decreased by 40 percent. Second, the decrease in the rate was age dependent (with the largest decreases for the youngest and the oldest, and the smallest decreases for the middle-aged). Third, the overall fatality rate increased from 1958 to 1968, but it decreased for each of the 4 following decades. Fourth, the changes in the rate for each decade were age dependent. Fifth, the patterns of these age-dependent changes varied across the decades. Examples of interventions that are likely to have age-dependent effects consistent with the obtained differential age changes in the fatality rate are discussed. However, other interventions are also likely to have relevant age-dependent effects on the fatality rate.

Objective: This study examined the changes in the relative proportions of male and female drivers between 1963 and 2010. Method: The analysis used data from the Federal Highway Administration. Results: During the period examined, the proportion of male drivers has gradually decreased. In 1963, males represented 60.4 percent of all drivers. Males became a minority in 2005. In 2010, they constituted 49.7 percent. A consideration of both the percentage of drivers by gender and the average annual miles driven by gender revealed that in 1963 about 76 percent of drivers on the road were males, which dropped to about 59 percent by 2010. Conclusions: Currently, females with a driver's license are slightly outnumbering males. However, because females drive less than males, the overall likelihood that a given driver on the road today is a female is still less than 50 percent.

Legislative changes and public media campaigns to prevent impaired driving are often cited as explanations for the reduction in the rate of impaired crashes over the past 25 years in most of the industrialized world. Other factors may have contributed to these reductions, such as changes in the age and sex distribution of the driver population. The primary purpose of this article is to assess the extent to which the reduction in impaired crashes in Ontario, Canada, may be attributable to the changing age and sex distribution of drivers. In Ontario, the rate of impaired crashes declined by 78.1% from 1974 to 1999. During this time period, the average age of drivers increased from 39.4 years in 1974 to 43.2 in 1999. Similarly, from 1974 to 1999 the percentage of all drivers that were women increased from 39.6% to 46.8%. Since statistics show the likelihood of impaired crashes is lower for both older drivers and women, the reduction of impaired crashes is partially due to these demographic changes. Using indirect standardization, the aging population accounted for an 8.6% decline in the rate of impaired crashes. The changing sex distribution of drivers accounted for a 9.4% decline in impaired crashes. Other global factors may also help to explain the reduction of impaired crashes, such as general road safety improvements and reductions in per adult consumption of alcohol.

Currently, the implementation of sobriety checkpoint programs, which have been demonstrated to be effective in reducing alcohol-related crashes, is limited by the belief that they require large consignments of police officers and result in few arrests. However, one of the earliest evaluations of a checkpoint program in Charlottesville, Virginia, demonstrated that effective checkpoints could be mounted in which police officers made as many arrests as officers on regular patrols. That study was printed by the NHTSA but was not published in a peer-reviewed journal. Because of its significance to current issues in the staffing of and procedures for checkpoint operations, this article reanalyzes the results of that study and describes the procedures implemented in checkpoints. A before-and-after control design was used to measure the change in nighttime crashes from three baseline years to the program year. Two analyses were conducted: the first on the percentage of all crashes occurring at night in the test city--Charlottesville--and the second on the percentage of all nighttime crashes in the state of Virginia that occurred in the test city. In addition, three waves of random-digit-dialing telephone surveys were conducted: one before and two during the checkpoint program in the test city, and the comparison city, Blacksburg. Finally, the number of impaired-driving arrests per officer hour at the checkpoints was compared with the number of arrests per hour by officers on regular patrol and the effect on arrests of the use of passive sensors was determined. The monthly percentage of nighttime crashes in Charlottesville was reduced by 17% (p = 000) in relation to the baseline level. The percentage of nighttime crashes in the state of Virginia that occurred in Charlottesville was reduced by 11% (p = .013) from baseline levels. Drivers arrested at checkpoints had lower BACs than those arrested by the regular patrols; however, the conviction rates were the same. The arrest per officer hour did not differ significantly between the two types of enforcement operations. Awareness of the checkpoint activity was high (72%) among nighttime at-risk drivers in the test city. Half reported seeing a checkpoint operation, and a quarter reported being interviewed. Use of a passive alcohol sensor by officers at the checkpoint increased arrests by almost a factor of three. The results of the evaluation suggest that small-scale sobriety checkpoints can be implemented as part of the regular enforcement program in moderate-sized jurisdictions and that they can be as efficient in producing arrests as standard enforcement patrols, particularly if passive alcohol sensors are used.

Background: Recent affluence, assisted by exploitation of hydrocarbon, has sparked unprecedented economic growth and influx of all façades of modernity in Oman. Different statistical models have examined the relationship between economic growth, motorization rates, and road traffic fatalities. However, such a relationship in Oman has never been described. Objective: To describe and analyze the trend of road traffic injuries (RTIs) in relation to motorization rates and economic growth during the period from 1985 to 2009 using Smeed's (1949) model and Koren and Borsos's (2010) model. Methods: The study is based on national data reported between 1985 and 2009. Data on the population and gross domestic product (GDP) per capita in U.S. dollars were gathered from the Ministry of National Economy reports. Data on the number of vehicles and road traffic crashes, fatalities, and injuries were gathered from the Royal Oman Police (ROP) reports. Crash, fatality, and injury rates per 1000 vehicles and per 100,000 population were computed. Linear regression analysis was carried out to estimate the average annual changes in the rates. Smeed's (1949) and Koren and Borsos's (2010) models were used to predict the relations between motorization and road traffic fatalities in Oman. In addition, a cross-sectional analysis of year 2007 data for a number of Arab countries was carried out. Results: The GDP per capita increased from US$6551 in 1985 to US$25,110 in 2009 with an annual increase of UR$547 per capita. The motorization rates increased by 36 percent from 1745 per 10,000 population in 1985 to 2382 per 10,000 population in 2009. Both Smeed's (1949) and Koren and Borsos's (2010) models had a high goodness of fit, with R(2) greater than 0.70. This indicated that road traffic fatalities in Oman may have a direct relationship with increased motorization. The cross-sectional analysis showed that the relation between crash fatalities and motorization rates in Oman and the United Arab Emirates can be better explained by Koren and Borsos's (2010) model than other countries. Conclusion: Recent economic growth in Oman was associated with an increase in motorization rates, which in turn has resulted in an increased burden of road traffic fatalities and injuries.

This study aimed to describe the trends of motorization and mortality rates from road traffic accidents and examine their associations in a rapidly urbanizing city in China, Shenzhen. Using data from Shenzhen Deaths Registry between 1994 and 2013, we calculated the annual mortality rates of road traffic accidents, in addition to the age- and sex-specific mortality rates and their annual percentage changes (APCs) for the period of 2000-2013. We also examined the associations between mortality rate of road traffic accidents and traffic growth with Spearman's rank correlation analysis and a log-linear model derived from the Smeed's law. A total of 20 196 deaths due to road traffic accidents, including 14 391 (71.3 %) male deaths and 5 805 (28.7 %) female deaths, were recorded in Shenzhen from 1994 to 2013. The annual mortality rates in terms of deaths per population and deaths per vehicle changed in similar patterns, demonstrating an increase since the year 1994 until peaking in 1997, followed by a steady decrease thereafter. The decrease in mortality was faster in individuals aged 20 year or older compare with those aged less than 20 years. The mortality rates in term of deaths per population was positively correlated with the total number of vehicles per km road but negatively correlated with the motorization rate in term of vehicles per population. The estimated model for deaths due to road traffic accidents in relation to the total population and the number of registered vehicles was ln (deaths / 10 000 vehicles) = -1.902 × ln (vehicles / population) - 1.961. The coefficient was statistically significant (P < 0.001) and the coefficient of determination was 0.966, indicating the goodness of model fit. We described a generally decreased trend in the mortality rates of road traffic accidents in a rapidly urbanizing Chinese city based observations in a 20-year period of 1994-2013. The decreased mortality rate may be explained by the expansion of road network construction, improved road safety regulations and management, as well as more accessible ambulance services in recent years. Nevertheless, road traffic accidents remain a universal problem of great public health concern in the whole population.

Motor vehicle crashes are the leading cause of death for 15-to 20-year-olds. In 2004, nearly 8,000 15to 20-year-old drivers were killed in crashes. Epidemiologic studies repeatedly identify overrepresentation of young males in fatal crashes. Recent studies of young females and risk-taking behaviors (drug use, violent crime, risky sexual behavior) show unfavorable trends. The objective of this study is to study the extent of contribution of young female drivers to national fatal crashes over and to uncover unfavorable trends linked to risky driving behavior. Data from the National Highway Traffic Safety Administration's Fatal Analysis Reporting System (FARS) on drivers in crashes with one or more fatalities during 1995-2004 were studied. Five age groups were used: 16, 17, 18, 19-20, and 21-24 years. Linear regression was used to measure trends over time. The regression results represent differences in proportions and changes in proportion of crashes that fell into specified categories. The FARS multiple imputation data sets was used to estimate the proportion of drivers with positive blood alcohol, and variance estimates were corrected for the imputation procedure. In all, 139,000 fatal crashes involving the noted age groups occurred over 10 years. Safety restraint use: Females had more safety restraint use (by 17.8%) but a smaller increase in use over time. Driver's license validity: The percentage of valid licensure decreased over the study for young males and females both in the general population and among drivers in fatal crashes. Single-vehicle crashes: A lower proportion of female drivers (8.9% fewer) were involved in single-vehicle fatal crashes. This proportion changed little over the study period. Alcohol use: Females had a 16.7% lower proportion than males of alcohol involvement in fatal crashes. This lower proportion was seen throughout the age groups. When accounting for change over the study period, female drivers had a similar to male increase in alcohol-involved fatal crashes. Presence of peer passengers: Female drivers were less likely to have age peers as passengers. While young male drivers surpass young females in number of fatal crashes, there are unfavorable trends linked to crash fatalities in young females. Our results suggest a smaller increase in safety restraint use, proportional decrease in license validity, and an increase in rate of alcohol-involved fatal crashes that approaches that seen in young males. These findings have considerable implications for future traffic safety social marketing campaigns, programs, and interventions.

Objectives: The objectives of this study were to (a) use data from the 2007 National Roadside Survey (NRS) to determine the characteristics of weekend nighttime drivers with positive blood alcohol concentrations (BACs) on U.S. roads in 2007; (b) determine the relationship of the driving environment and trip characteristics associated with drinking drivers; and (c) compare the findings for the 2007 NRS with those for the 1996 NRS. Methods: Like the 1996 NRS, the 2007 NRS used a stratified random national roadside survey sample of the contiguous 48 states and collected nighttime data on Fridays and Saturdays between 10 p.m. and 3 a.m. Officers directed 8384 drivers into off-road parking areas where our research team asked them to participate in the survey. Results: Of those approached, 7159 (85.4%) provided a breath test. Results revealed that 12 percent of the nighttime drivers had positive BACs, and of those, 2 percent were higher than the 0.08 BAC illegal limit in the United States. Since the 1996 NRS, we found significant reductions in the percentage of BAC-positive drivers across different demographic groups. Age was among the most significant factors associated with a weekend driver having a positive BAC. The probability that a driver would be drinking peaked in the 21- to 25-year-old age group. Male drivers were more likely than female drivers to be drinking, and Asian and Hispanic drivers were less likely than white drivers to be drinking. Drinking drivers were more likely to be driving short distances (5 or fewer miles) late at night (between 1 and 3 a.m.) and to be coming from a bar or restaurant. Finally, 26 percent of the drivers who reported that they would drive less than 5 miles on the night of the survey had positive BACs, compared to only 16 percent who indicated that they would drive between 6 and 20 miles and 10 percent who planned to drive more than 20 miles. Conclusions: The 2007 NRS provides another benchmark in the 4-decade record of drinking drivers on American roads and provides a basis for measuring progress in combating driving under the influence during the coming decade.

To describe bicyclist fatalities in a traffic-dense, urban environment. Multiple New York City (NYC) agencies provided information on bicyclist deaths. Fatality Analysis Reporting System (FARS) data were used to compare NYC's bicyclist fatality rate involving motor vehicles with rates in comparable urban centers. Between 1996 and 2005, 225 bicyclists died in NYC. Most fatalities resulted from motor vehicle crashes (92%). Men in NYC had higher death rates than women, and no age group had higher risk. Most of NYC's bicyclist fatalities occurred at intersections (88%). Head injuries contributed to 77 percent of deaths; helmet use was rare (3%). Most fatal crashes (91%) involved motorist and bicyclist factors, such as inattention and unsafe speed. Alcohol was detected in 21 percent of bicyclists dying within 3 hours of a crash; motorist alcohol use was a contributing factor in 6 percent of crashes. Over half were on multi-lane roads (53%). Large vehicles were involved in 30 percent of crashes but comprise 5-17 percent of road vehicles. Bicyclist fatality rates involving motor vehicles in NYC were comparable to those of other cities. Findings suggest the merits of multipronged efforts to prevent crashes and to improve bicyclist safety in NYC and in other dense, urban environments. Motorists and bicyclists should be made aware of the risks of alcohol use and the benefits of helmet-wearing. Road users should pay attention to traffic control measures and travel at safe speeds. Interventions that control traffic at intersections and on multilane streets, that dedicate and demarcate routes for motorists and cyclists, and that improve visibility, especially for large vehicles, warrant consideration.

The objective of this article was to explore overall crash and injury trends over the past decade for young drivers residing in New South Wales (NSW), Australia, including gender and age disparities. Passenger vehicle crashes for drivers aged 17-25 occurring during 1997-2007 were extracted from the state crash database to calculate crash rates (per licensed driver). Generalized linear models were used to examine crash trends over time by severity of driver injury, adjusting for age, gender, rurality of residence, and socioeconomic status. Yearly adjusted relative risks of crash by gender and by age group were also examined over the study period. Young driver noninjury and fatality rates significantly decreased by an average of 4 percent (95% CI: 4-5) and 5 percent (95% CI: 0-9) respectively each year from 1997 to 2007. Young driver injury rates significantly increased by about 12 percent (95% CI: 9-14) to the year 2001 and then significantly decreased. The relative risk of crash (regardless of driver injury) for males compared to females significantly decreased over time. Compared to drivers aged 21-25, drivers aged 17 and particularly 18- to 20-year-olds had significantly and consistently higher crash risks across the study period. Overall, there has been a significant decline in young driver crashes in NSW over the last decade. Regardless of injury severity, males' risk of crash has reduced more than female young drivers, but drivers aged 17 continue to be at higher risk. These findings provide feedback on potential road safety successes and areas needing specific interventions for future improvements.

Motor vehicle collisions (MVCs) are the leading cause of occupational fatalities in Kentucky as well as in the nation. The characteristics of and contributing factors for occupational versus nonoccupational MVC fatalities in the Commonwealth of Kentucky were examined from 1998 to 2000. Semi trucks were most frequently involved in fatal occupational MVCs, and passenger cars were most frequently involved in nonoccupational MVCs. More than half of the decedent drivers resided outside of Kentucky. The percentage of occupational fatalities occurring on a four-lane highway was double the percentage observed for nonoccupational MVC fatalities. In addition, an increased proportion of occupational MVC deaths occurred on limited access highways compared to nonoccupational fatalities. When human factors contributing to these fatal incidents were examined, the two primary human factors involved in occupational motor vehicle fatalities were driver distraction/inattention and falling asleep, whereas unsafe speed and alcohol were the primary human factors contributing to a nonoccupational fatality. These results suggest that semi drivers traveling on four-lane highways are more at risk for a fatal occupational injury in Kentucky. Therefore, additional epidemiological studies are needed to further examine human factors, the nature of the Kentucky highway system, and trucking controls (e.g., weigh station hours of operation) within the Kentucky transportation industry.

The price of gasoline has been found to be negatively associated with traffic crashes in a limited number of studies. However, most of the studies have focused either on fatal crashes only or on all crashes but measured over a very short time period. In this study, we examine gasoline price effects on all traffic crashes by demographic groups in the state of Alabama from 1999 to 2009. Using negative binomial regression techniques to examine monthly data from 1999 to 2009 in the state of Alabama, we estimate the effects of changes in gasoline price on changes in automobile crashes. We also examine how these effects differ by age group (16-20, 21-25, 26-30, 31-64, and 65+), gender (male and female), and race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The results show that gasoline prices have both short-term and long-term effects on reducing total traffic crashes and crashes of each age, gender, and race/ethnicity group (except Hispanic due to data limitations). The short-term and long-term effects are not statistically different for each individual demographic group. Gasoline prices have a stronger effect in reducing crashes involving drivers aged 16 to 20 than crashes involving drivers aged 31 to 64 and 65+ in the short term; the effects, however, are not statistically different across other demographic groups. Although gasoline price increases are not favored, our findings show that gasoline price increases (or decreases) are associated with reductions (or increases) in the incidence of traffic crashes. If gasoline prices had remained at the 1999 level of $1.41 from 1999 to 2009, applying the estimated elasticities would result in a predicted increase in total crashes of 169,492 (or 11.3%) from the actual number of crashes. If decision makers wish to reduce traffic crashes, increasing gasoline taxes is a possible option-however, doing so would increase travel costs and lead to equity concerns. These findings may help to shape transportation safety planning and policy making.

The majority of motor vehicle occupants who were killed or hospitalized in crashes in Kentucky in 2000-2001 occupied vehicles that were severely damaged in the crash. Even so, overall only a small percentage of all severely damaged vehicle occupants were killed or hospitalized. The purpose was to identify occupant, vehicle, crash, and roadway/environmental factors that were associated with increased risk of severe injury in crashes where the occupant's vehicle was severely damaged. This study probabilistically linked Kentucky's statewide motor vehicle crash and inpatient hospital discharge data files for 2000 and 2001, and selected cases representing occupants of vehicles that were reported by police as having either "severe" or "very severe" damage. For occupants who were identified through data linkage as having been hospitalized, the Injury Severity Score (ISS) was calculated using ICDMAP-90 software, and the scores were stratified into the following categories: critical (>24), severe (15-24), moderate (9-14), and mild (<9). We then created an outcome variable, injury severity level, with five levels: killed; hospitalized with at least moderate injuries (ISS = critical, severe, or moderate); hospitalized with mild injuries (ISS = mild); injured according to the police report but not hospitalized; and no apparent injury according to the police report. We performed a stepwise, ordinal logistic regression of injury severity, using independent variables identified from the existing crash literature. Occupant risk factors for higher levels of injury severity selected by the regression were age (risk increased with age, other factors being equal), female gender, restraint non-use, ejection from the vehicle, and driver impairment (by alcohol and/or drugs). Crash risk factors included head-on collision, collision with a fixed object, vehicle rollover, and vehicle fire. Roadway/environmental factors were federal- or state-maintained roadway and posted speed limit 89 kph (55 mph) or greater. Many of the identified risk factors are explicitly or implicitly mentioned in the strategic plans of key organizations involved in highway safety and injury prevention in Kentucky. Our analysis provides additional evidence of their importance, and confirms that their mitigation will reduce injury severity in crashes involving severe vehicle damage. Additionally, older occupants and female occupants showed increased risks of serious injury, but to our knowledge these factors are not currently addressed in any state plans. An opportunity exists to clarify the nature of these risks through further studies, which might lead to the identification of countermeasures specific to these populations.

Objectives: The objective of the current study is to determine the contribution of Chile's 2005 traffic law reform, police enforcement, and road investment infrastructure to the reduction of traffic fatalities and severe injuries from 2000 to 2012. Methods: Analyses based on structural equation models were carried out using a unique database merging aggregate administrative data from several Chilean public institutions. The sample was balanced (13 regions, over 13 years; N=169). Dependent variables were rates of traffic fatality (total, drivers, passengers, and pedestrians), severe injuries, and total number of crashes per vehicle fleet. Independent variables were (1) traffic law reform, (2) police enforcement, and (3) road infrastructure investment. Oil prices, alcohol consumption, proportion of male population 15-24 years old, unemployment, years' effects and regions' effects, and lagged dependent variables were entered as control variables. Results: Empirical estimates from the structural equation models suggest that the enactment of the traffic law reform is significantly associated with a 7% reduction of pedestrian fatalities. This association is entirely mediated by the positive association the law had with increasing police enforcement and reducing alcohol consumption. In turn, police enforcement is significantly associated with a direct decrease in total fatalities, driver fatalities, passenger fatalities, and pedestrian fatalities by 17%, 18%, 8%, and 60%, respectively. Finally, road infrastructure investment is significantly associated with a direct reduction of 11% in pedestrian fatalities, and the number of total crashes significantly mediates the effect of road infrastructure investment on the reduction of severe injuries. Tests of sensitivity indicate these effects and their statistical significance did not vary substantively with alternative model specifications. Conclusions: Results suggest that traffic law reform, police enforcement, and road infrastructure investment have complex interwoven effects that can reduce both traffic fatalities and severe injuries. Though traffic reforms are ultimately designed to change road user behaviors at large, it is also important to acknowledge that legislative changes may require institutional changes--that is, intensification of police enforcement--and be supported by road infrastructure investment, in order to effectively decrease traffic fatalities and injuries. Furthermore, depending on how road safety measures are designed, coordinated, and implemented, their effects on different types of road users vary. The case of Chile illustrates how the diffusion of road safety practices globally promoted by the World Health Organization and World Bank, particularly in 2004, can be an important influence to enhance national road safety practices.

On December 1, 2000, new legislation came into force in Victoria, Australia, that involved a framework for the procedure to be followed by the police for the detection of drivers impaired by drugs other than alcohol. An integral part of the procedure is the use of performance tests known as the standardized field sobriety tests (SFSTs) and the analysis of blood samples for the presence of drugs other than alcohol. This paper outlines the new legislative framework and the drug impairment detection procedures currently in place in Victoria. This paper also evaluates the data collected using the framework for the first five years since implementation in Victoria.

Objective: To investigate comparative road user crash and fatality rates in Japan between 2000 and 2010 in the elderly and young. Methods: Data from the Japan Ministry of Health, Labor and Welfare Vital Statistics Database and the Institute for Traffic Accident Research and Data Analysis were used to calculate crash rates by age group, vehicle, and license category. Results: Fatal crash rates per 100,000 licensed drivers for 4-wheeled motor vehicle drivers decreased by 53, 56, and 42 percent among the 65-69, 70-74, and ≥75 age groups between 2000 and 2010, respectively, compared to 66 and 60 percent among the 16-19 and 20-24 age groups, respectively. Fatal crash rates per 100,000 licensed riders for 2-wheeled motor vehicles decreased by 64, 23, and 33 percent in the 65-69, 70-74, and ≥75 age groups, respectively. Similarly, fatal crash rates per million population among bicyclists and pedestrians decreased in all age groups but were highest in the elderly age group in all years; the annual fatal crash rate for elderly pedestrians was 3 to 10 times higher than that for younger pedestrians. Conclusions: Despite the overall decrease in the elderly crash and fatal crash rates in all road use categories, elderly pedestrians are more susceptible to road traffic crashes and are more likely to be killed than younger persons. Further research may reduce this risk.

The possible connection between diseases among drivers and traffic accidents was examined for traffic safety purposes. We studied medical conditions of drivers and passengers in all motor vehicle crashes with fatalities in Finland in 2001 and 2002 by using reports of road accident investigation teams, including autopsy reports. We analyzed a total of 542 crashes with 640 fatalities. Findings were also compared with available epidemiological data in Finland. An insignificant difference in the number of reported diseases was present between the different parties involved in crashes. However, among killed key drivers, so-called A-parties, psychiatric diseases, especially alcoholism, depression, and unspecific mental disorders, were diagnosed more often than in the groups of other drivers or passengers. In addition, A-parties were reported to more frequently suffer from cerebral arteriosclerosis and arterial hypertension. Drivers' diseases can be a risk factor for traffic accidents. Fitness to drive should therefore be considered in medical practice, particularly in patients with alcoholism and other psychiatric disorders.

Key features of graduated licensing were introduced in 46 states and the District of Columbia between 1993 and 2003. State evaluations consistently have reported positive overall effects and positive effects of nighttime and passenger restrictions. Sixteen year-olds are the main target of graduated licensing, and the present study investigated changes in their fatal crash involvement and crash characteristics that have taken place nationally during 1993-2003. By looking at 16 year-olds nationally, the study does not constitute a direct test of the effect of graduated licensing laws per se. Data on fatal crashes were obtained from the Fatality Analysis Reporting System. Sixteen year-olds were compared with older drivers. During these years, the extent to which 16-year-old drivers were in fatal crashes decreased substantially compared with older age groups. The drop in the per capita crash rate for 16 year-olds was 26%. The major change was a reduction in crashes involving transporting young passengers, especially in jurisdictions with restrictions that target these crashes. There was no change in the proportion of fatal late-night crashes even in states restricting this activity. There has been some progress nationally in reducing the crash problem for 16 year-olds, but this still is a big problem. To achieve further progress, the gaps and weaknesses in present graduated licensing laws will need to be addressed.

In December 2004, a new legislative framework for the random drug screening of drivers modeled on the successful random alcohol screening methodology came into force in Victoria, Australia. The new framework prohibits driving while methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), and cannabis, delta-9-tetrahydrocannabinol (THC), are present at any level in a driver's specimen. This is enforced by police who have the legislative authority to randomly drug test drivers for the presence of MA, MDMA, and THC by oral fluid (saliva) sample screening at the roadside. This article outlines the new random drug testing legislative framework and the drug testing procedures currently in place in Victoria. This article also examines the data collected through the operation of the framework for the first two years since implementation in Victoria (December 2004-December 2006).

Federal rules regulate work hours of interstate commercial truck drivers. On January 4, 2004, a new work rule was implemented, increasing daily and weekly maximum driving limits and daily off-duty requirements. The present study assessed changes in long-distance truck drivers' reported work schedules and reported fatigued driving after the rule change. Associations between reported rule violations, fatigued driving, and schedule as well as other characteristics were examined. Samples of long-distance truck drivers were interviewed face-to-face in two states immediately before the rule change (November-December 2003) and about 1 year (November-December 2004) and 2 years (November-December 2005) after the change. Drivers reported substantially more hours of driving after the rule change. Most drivers reported regularly using a new restart provision, which permits a substantial increase in weekly driving. Reported daily off-duty and sleep time increased. Reported incidents of falling asleep at the wheel of the truck increased between 2003 (before the rule change) and 2004 and 2005 (after the change); in 2005 about one fifth of drivers reported falling asleep at the wheel in the past month. The frequency of reported rule violations under the old and new rules was similar. The percentage of trucks with electronic on-board recorders increased significantly to almost half the fleet; only a few drivers were using automated recorders to report rule compliance. More than half of drivers said that requiring automated recorders on all large trucks to enforce driving-hour limits would improve compliance with work rules. Based on the 2004-2005 survey data, drivers who reported more frequent rule violations were significantly more likely to report fatigued driving. Predictors of reported violations included having unrealistic delivery schedules, longer wait times to drop off or pick up loads, difficulty finding a legal place to stop or rest, and driving a refrigerated trailer. Reported truck driver fatigue increased after the new rule was implemented, suggesting that the rule change may not have achieved the goal of reducing fatigued driving. Reported violations of the work rules remain common. Because many trucks already have electronic recorders, requiring them as a means of monitoring driving hours appears feasible.

To estimate the costs of motor vehicle-related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. Motor vehicle-related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle-related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available.

Objective: This study examines the role of unendorsed motorcycle operators in fatal motorcycle crashes and the interrelationships of endorsement status and motorcycle type with operator characteristics like riding impaired. Methods: Cases were drawn from a database tracking fatal crashes occurring within Cuyahoga County, Ohio, from 2005 to 2011. Analysis focused on 75 fatal motorcycle crashes in which the deceased motorcycle operators were male and coroner's reports, police crash reports, and license endorsement status were available. Analysis included comparison of means, chi square testing, and binary logistic regression. Results: More than half of motorcyclists (53%) did not have motorcycle endorsements. Mean age of unendorsed riders was 36.8 years, compared to 44.2 years for endorsed riders. Motorcyclists were considered at fault in 69 percent of cases, most often due to reckless operation, failure to control, or speeding. Mean blood alcohol concentration for fatally injured motorcyclists was 0.06 percent. Marijuana was the most common drug identified in blood tests. Nonendorsement was associated with younger age, single-vehicle crash, and having a prior license suspension. Neither endorsement status nor bike type was associated with likelihood of testing positive for alcohol or drugs of abuse. Riders of sport motorcycles were more likely than cruiser/touring bike operators to be wearing helmets and less likely to be endorsed. Conclusion: The large proportion of unendorsed motorcyclists involved in fatal crashes in northeast Ohio highlights the need for more stringent licensing requirements that make it more difficult to ride without an endorsement and limit learner's permit renewals.

Objective: Child restraint systems (CRS) are increasingly being designed to accommodate larger children and to mitigate side impact injuries. Little is known about the impact of CRS on the safety of other vehicle passengers due to limitations of existing crash databases. This study provides the first assessment of the seating positions occupied by child passengers and the relationship between CRS and other second-row passengers in a national sample of vehicles transporting children. Methods: A secondary analysis was conducted of data from the 2007-2009 National Survey of the Use of Booster Seats (NSUBS), a direct in-vehicle observational study of child passenger restraint use. Passengers riding in the same vehicle were identified and passenger position was determined. Vehicles with second-row child passengers were included in analyses of seat positions occupied by child passengers with and without CRS. Frequency counts for the different combinations of CRS and passengers in second rows were calculated. Results: Of the 17,065 vehicles observed in 2007-2009 NSUBS, 14,506 (85%) vehicles contained at least 1 child passenger in a second row that contained no more than 3 total passengers. Of these 14,506 vehicles, 55 percent contained a lone child passenger in the second row. A CRS was in use in 4656 (59%) of the 7949 vehicles with a lone child passenger in the second row compared to 4077 (62%) of the 6557 vehicles with multiple passengers in the second row (P < .001). A passenger was adjacent to a CRS within 1333 (33%) of the 4077 vehicles containing a CRS in the second row. There were 3 second-row passengers in nearly 1 in 5 vehicles containing a CRS in the second row. Conclusion: Adults and children not using CRS are frequently seated in vehicle second rows adjacent to a child restrained in a CRS. These findings should be used to inform the regulation, design, and testing of CRS and to determine the risks of larger CRS designs to other passengers seated in the same vehicle row relative to the benefits of the CRS for the passenger it restrains.

Objective: The objectives of this study were to estimate the prevalence of designated driving in the United States, compare these results with those from the 1996 National Roadside Survey, and explore the demographic, drinking, and trip characteristics of both designated drivers and their passengers. Methods: The data used were from the 2007 National Roadside Survey, which randomly stopped drivers, administered breath tests for alcohol, and administered a questionnaire to drivers and front seat passengers. Results: Almost a third (30%) of nighttime drivers reported being designated drivers, with 84 percent of them having a blood alcohol concentration of zero. Drivers who were more likely to be designated drivers were those with a blood alcohol concentration that was over zero but still legal; who were under 35 years of age; who were African American, Hispanic, or Asian; and whose driving trip originated at a bar, tavern, or club. Over a third of passengers of designated drivers reported consuming an alcoholic drink the day of the survey compared to a fifth of passengers of nondesignated drivers. One fifth of passengers of designated drivers who reported drinking consumed 5 or more drinks that day. Conclusions: Designated driving is widely used in the United States, with the majority of designated drivers abstaining from drinking alcohol. However, because designated driving separates drinking from driving for passengers in a group traveling together, this may encourage passengers to binge drink, which is associated with many adverse health consequences in addition to those arising from alcohol-impaired driving. Designated driving programs and campaigns, although not proven to be effective when used alone, can complement proven effective interventions to help reduce excessive drinking and alcohol-impaired driving.

Objective: To provide updated estimates of the relationship between the number and ages of passengers present in a vehicle and the crash risk per mile driven of 16- and 17-year-old drivers. Methods: Data on crashes that occurred in years 2007-2010 and data on the number of miles driven in years 2008-2009 were examined. Rates of crash involvement and driver death per mile driven were estimated for 16- and 17-year-old drivers with no passengers; with 1, 2, and 3 or more passengers younger than age 21 (and no older passengers); and with at least 1 passenger aged 35 or older. Results: For 16- and 17-year-old drivers, having 1 passenger younger than age 21 (and no older passengers) was associated with 44 percent greater risk per mile driven of being killed in a crash, compared to having no passengers (relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.01-2.04). Having 2 passengers younger than age 21 was associated with double the risk of being killed in a crash, compared to having no passengers (RR: 2.02, 95% CI: 1.36-2.99). Having 3 or more passengers younger than age 21 was associated with roughly quadruple the risk of being killed in a crash, compared to having no passengers (RR: 4.39, 95% CI: 1.45-13.31). The relative risk of being involved in any police-reported crash in the presence of young passengers followed a similar pattern; however, the differences in risks of being involved in any police-reported crash were smaller and were not statistically significant. Having at least 1 passenger aged 35 or older in the vehicle was associated with a 62 percent lower risk per mile driven of being killed in a crash (RR: 0.38, 95% CI: 0.24-0.60) and a 46 percent lower risk of being involved in any police-reported crash (RR: 0.54, 95% CI: 0.31-0.93) for 16- and 17-year-old drivers, compared to having no passengers. Conclusions: These results show that although the overall number of teen driver fatalities has decreased substantially over the past several years, carrying young passengers is still a significant risk factor for young drivers. In contrast, carrying adult passengers is associated with significantly lower risk of crash involvement.

Objective: To examine alcohol and drug use among random drivers in different regions of Norway by analyzing oral fluid, compare drivers in urban and rural areas, compare with results from the roadside survey in southeastern Norway in 2005-2006, and roughly estimate the prevalence of driving with blood drug concentrations above the new Norwegian legislative limits among random drivers. This roadside survey was part of the European DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines) Project. Methods: Drivers were selected for a voluntary and anonymous study using a stratified multistage cluster sampling procedure in collaboration with the Mobile Police Service. Samples of oral fluid were taken using the Statsure Saliva Sample (Statsure Diagnostic Systems, Framingham, MA), and the drivers' gender, age, and nationality were recorded. Samples of oral fluid were analyzed for alcohol or drugs, for a total 28 psychoactive substances. Results: One hundred eighty-four roadside survey sessions were conducted and 10,004 drivers were asked to participate. The refusal rate was 5.8 percent. Psychoactive substances were found in 4.8 percent of the 9410 oral fluid samples analyzed. Alcohol was detected in 0.3 percent, medicinal drugs in 3.2 percent, and illegal drugs in 1.5 percent of the samples. Illegal drugs were significantly more frequently detected in samples from southeastern Norway including the capital Oslo, whereas medicinal drugs were more frequently detected in samples from southeastern Norway excluding Oslo. Illegal drugs were significantly more frequently detected in samples from drivers in urban areas than in rural areas, though there were no significant differences for alcohol and medicinal drugs. Medicinal drugs were most commonly found in samples collected during the daytime on weekdays (3.8%), and illegal drugs were most commonly found in samples collected during late night on weekdays or weekends (2.8%-3.2%). The most commonly found substances were the sleeping agent zopiclone (1.4%), the main active substance in cannabis tetrahydrocannabinol (1.1%), and the sedative drug diazepam (0.7%). The prevalence of driving with drug concentrations above the Norwegian legislative limits for blood was estimated to be about 0.2 percent for alcohol, 0.6 percent for illegal drugs, and about 1.3 percent for medicinal drugs. Conclusions: The incidence of drink driving was very low, though driving after using psychoactive illegal or medicinal drugs was more frequent.

Road traffic injuries are one of the leading causes of preventable unintentional injury. The European Injury Database estimated that in EU-27 countries road traffic injuries account for 10% of all injuries treated in the emergency department or admitted to the hospital, accounting for 4.2 million victims each year. We examined the characteristics and outcomes of road traffic injuries treated in a large emergency department in Romania by different types of road users. Secondary data analysis was conducted on a sample of patients who suffered a transport related injury and received care at the Emergency Department of Mures County Emergency Hospital in Romania. Data was collected by two trained emergency physicians between March 2009 and July 2010, as part of the European Injury Database project. Information about demographics, mechanism, nature, place of occurrence, and activity of injury; treatment and follow-up and mode of transport were described for five different categories of road users: animal drawn vehicle (operator and passenger), passenger car (driver and passenger), motorcycle (driver and passenger), bicyclist and pedestrian. A total of 2782 patients were treated in the emergency department, of which 718 (25.8%) were road traffic injuries. The male to female ratio was 2:1. The highest percentage of patients were injured in passenger cars (49%), followed by motorcycles (16.7%). For both types of road users, the majority of patients were between the ages of 18 and 29. Pedestrian injuries accounted for 14.6%, of which a third were children up to the age of 17 and 40% were adults and elderly over the age of 50. The majority of patients were injured due to contact with a moving object (48.1%), followed by contact with static object (23.5%), then falling, stumbling, jumping, or being pushed (19.6%). Contusion and bruises (54.9%) were the most common diagnosis, followed by fractures (20.1%) and open wounds (10.2%) for all road user categories. The most common part of the body injured for all road user categories was the head region (42.3%). Of the 34.9% patients treated and admitted to the hospital, 30% had a length of stay between 4 and 7 days. Understanding the extent, nature and characteristics of road traffic injuries may help to identify vulnerable road users in specific settings and implement the most effective prevention strategies targeting the most affected populations.

Objective: This analysis is an update of a Traffic Tech published by the National Highway Traffic Safety Administration (NHTSA) in March 1992. Drivers with prior driving-while-intoxicated (DWI) convictions are overrepresented in fatal crashes and the relative risk of fatal crash involvement is greater for these repeat DWI offenders. Methods: Although it is estimated that 2.1 percent of licensed drivers had a prior arrest for DWI within the past 3 years in 2010, 8.0 percent of intoxicated drivers (blood alcohol concentration [BAC] ≥ 0.08 g/dL) involved in fatal crashes had at least one prior DWI conviction in the past 3 years during that same year. Results: Drivers with prior DWI convictions are overrepresented in fatal crashes by a factor of 1.62 or are 62 percent more likely to be in a fatal crash. Similarly, drivers with prior DWI convictions are also overrepresented as drinking drivers in fatal crashes: those with low BACs (0.01-0.07) by a factor of 2.38 and those with high BACs (0.08+) by a factor of 3.81. Conclusion: Though repeat DWI offenders are at a substantially higher risk of fatal crash involvement, the vast majority of intoxicated drivers in fatal crashes do not have a DWI conviction in the past 3 years (11 out of 12) according to the Fatality Analysis Reporting System records for the year 2010.

Objectives: When used correctly, child safety seats reduce the risk of injury to a child passenger compared to seat belts. The objectives of this study are to (1) describe restraint use among Canadian children ages 4-8 years in 2010; (2) compare child safety seat use between provinces with new legislation (post-2006), old legislation (pre-2006), and without legislation; and (3) compare child safety seat use rates from 2006 to 2010. Methods: Roadside observational surveys of child restraint use were performed in 2006 and 2010 using a nationally representative stratified sample. Proportions of restraint use, correct use (i.e., child safety seats and booster seats) in 4- to 8-year-old children was examined between 3 groups: provinces with new legislation (i.e., child safety seat legislation that included implementation of specific legislation for booster seat use for child passengers ages 4-8 years), old legislation, and no legislation. Results: There were 4048 children observed as passengers in motor vehicles. In provinces with new legislation, 84 percent (95% confidence interval [CI], 72.2-90.8) of children were restrained compared to 94.9 percent (95% CI, 93.0-96.7) in provinces with old legislation, and 81.8 percent (95% CI, 77.3-86.3) in provinces without legislation. Correct use of child restraint was 54.1 percent (95% CI, 48.0-60.3) in provinces with new legislation, 29.5 percent (95% CI, 25.9-33.2) in provinces with old legislation, and 52.0 percent (43.0-61.0) in provinces without legislation in 2010. Conclusion: The findings from this study suggest that child safety seat legislation has an impact on restraint use in Canada. Despite the increase in rates of child safety seat use in provinces with new legislation and stable rates in provinces with old legislation, use rates remain low. Injury prevention strategies including further surveillance, interventions, and enforcement of restraint use in children are important to decrease motor vehicle related injury and death.

The biofidelity of the injury criteria used by Federal Motor Vehicle Safety Standards (FMVSS) No. 218 was examined against biomechanically based injury metrics. An experimental method was developed to measure the helmet contact pressure distribution on a headform during an impact attenuation test. The headform pressure data from eighty impact tests to the front, crown, and side of a helmet were used in finite element model simulations to predict skull fracture. Using headform acceleration data as inputs, the Simulated Injury Monitor software package (SIMon) was used to predict brain injuries for concussion, brain contusion, and subdural hematoma. It was found that FMVSS No. 218 headform peak acceleration is the best correlate with injury metrics. Dwell times over 150 and 200 g both had poor correlation with injury metrics. The failure probability for skull fracture agrees with published results at similar linear accelerations. Concussion results were inconclusive. This research has shown that peak head acceleration can be an acceptable injury metric for the FMVSS No. 218 test method. However, the current 400 g allows for a high probability of head injury. An adjusted linear head acceleration limit of 210 g predicts a 15 percent skull fracture probability. The FMVSS No. 218 test method is adequate for predicting skull fracture based on peak head acceleration limits. However, due to the use of the rigid head/neck assembly that restricts rotation, the test method is likely inadequate for predicting brain injuries.

This 12-month prospective multi-center study was designed to ascertain the entire injury profile, injury severity, and risk factors in motorcycle injured Nigerian maxillofacial patients. With a validated investigator-administered questionnaire, we obtained data from motorcycle-injured in- and out-patients managed in the maxillofacial units of four Nigerian teaching hospitals. Standardized information on host factors, agent, and type of crash as well as location, type, and extent of injury were elicited. Injuries were scored using the Facial Injury Severity and Abbreviated Injury scales (FISS, AIS). A significant male preponderance was observed (p = 0.003) with peak age 21-30 years; 62.7% of the patients were riders. Alcohol/substance abuse was implicated in 31.2% of riders, fatigue in 13.5%, and bad roads in 17.6%. The rate of helmet use was 3%. The predominant type of crash was head-on collision (HOC) 58%). Glasgow Coma Scale (GCS) score ranged from 5 to 15 with mean 13.3 (3.5); Facial Injury Severity Score (FISS) ranged from 1 to 11, mean 3.7 (1.9); and Abbreviated Injury Score was mostly 2. FISS was not significantly different between both genders (p = 0.26) and road types (p > 0.05). The mean FISS was greater with multiple passengers than with single or no passengers (p = 0.12) and lower with crashes involving motorcycles carrying heavier loads (p = 0.022). Six of the patients died (2.7% fatality) in the course of their hospitalization all within a month of injury. We advocate prompt legislation of a ban on greater than one passenger on a motorcycle, impaired (substance abuse) operation on a motorcycle, and stronger enforcement of speed limit and adoption of legislation that would make it mandatory to wear a full-face helmet when operating a motorcycle in Nigeria.

Objective: This article describes the chest injury risk reduction effect of shoulder restraints using finite element (FE) models of the worldwide harmonized side impact dummy (WorldSID) and Total Human Model for Safety (THUMS) in an FE model 32 km/h oblique pole side impact. Methods: This research used an FE model of a mid-sized vehicle equipped with various combinations of curtain shield air bags, torso air bags, and shoulder restraint air bags. As occupant models, AM50 WorldSID and THUMS AM50 Version 4 were used for comparison. Results: The research investigated the effect of shoulder restraint air bag on chest injury by comparing cases with and without a shoulder side air bag. The maximum external force to the chest was reduced by shoulder restraint air bag in both WorldSID and THUMS, reducing chest injury risk as measured by the amount of rib deflection, number of the rib fractures, and rib deflection ratio. However, it was also determined that the external force to shoulder should be limited to the chest injury threshold because the external shoulder force transmits to the chest via the arm in the case of WorldSID and via the scapula in the case of THUMS. Because these results show the shoulder restraint air bag effect on chest injury risk, the vent hole size of the shoulder restraint air bag was changed for varying reaction forces to investigate the relationship between the external force to the shoulder and the risk of chest injury. In the case of THUMS, an external shoulder force of 1.8 kN and more force from the shoulder restraint air bag was necessary to help prevent rib fracture. Increasing external force applied to shoulder up to 6.2 kN (the maximum force used in this study) did not induce any rib or clavicle fractures in the THUMS. When the shoulder restraint air bag generated external force to the shoulder from 1.8 to 6.2 kN in THUMS, which were applied to the WorldSID, the shoulder deflection ranged from 35 to 68 mm, and the shoulder force ranged from 1.8 to 2.3 kN. Conclusions: In the test configuration used, a shoulder restraint using the air bag helps reduce chest injury risk by lowering the maximum magnitude of external force to the shoulder and chest. To help reduce rib fracture risk in the THUMS, the shoulder restraint air bag was expected to generate a force of 3.7 kN with a minimum rib deflection ratio. This corresponds to a shoulder rib deflection of 60 mm and a shoulder load of 2.2 kN in WorldSID. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Objectives: Whiplash-associated disorders (WADs), or whiplash injuries, due to low-severity vehicle crashes are of great concern in motorized countries and it is well established that the risk of such injuries is higher for females than for males, even in similar crash conditions. Recent protective systems have been shown to be more beneficial for males than for females. Hence, there is a need for improved tools to address female WAD prevention when developing and evaluating the performance of whiplash protection systems. The objective of this study is to develop and evaluate a finite element model of a 50th percentile female rear impact crash test dummy. Methods: The anthropometry of the 50th percentile female was specified based on literature data. The model, called EvaRID (female rear impact dummy), was based on the same design concept as the existing 50th percentile male rear impact dummy, the BioRID II. A scaling approach was developed and the first version, EvaRID V1.0, was implemented. Its dynamic response was compared to female volunteer data from rear impact sled tests. Results: The EvaRID V1.0 model and the volunteer tests compared well until ∼250 ms of the head and T1 forward accelerations and rearward linear displacements and of the head rearward angular displacement. Markedly less T1 rearward angular displacement was found for the EvaRID model compared to the female volunteers. Similar results were received for the BioRID II model when comparing simulated responses with experimental data under volunteer loading conditions. The results indicate that the biofidelity of the EvaRID V1.0 and BioRID II FE models have limitations, predominantly in the T1 rearward angular displacement, at low velocity changes (7 km/h). The BioRID II model was validated against dummy test results in a loading range close to consumer test conditions (EuroNCAP) and lower severity levels of volunteer testing were not considered. Conclusions: The EvaRID dummy model demonstrated the potential of becoming a valuable tool when evaluating and developing seats and whiplash protection systems. However, updates of the joint stiffness will be required to provide better correlation at lower load levels. Moreover, the seated posture, curvature of the spine, and head position of 50th percentile female occupants needs to be established and implemented in future models.

The study evaluated associations between outcome measures used in driving research including self-reported crashes, state crash records, and an on-road driving test (ORT). A total of 750 community dwelling participants aged 69 to 95 were recruited via the electoral roll into a study on injury prevention. Of these, 509 were drivers, and data on self-reported crashes, and either state crash records, or an on-road assessment were available for 488. Crash history data were obtained from state records (five-year retrospective and twelve-month prospective), retrospective self-report (five-year) and prospective monthly injury diaries (twelve months). A subsample completed an on-road driving test. During the last five years, 22.3% reported a crash, 10.0% reported a crash in the twelve-month follow-up period, 3.2% of the sample had state crash records during the previous five years, and 0.6% had state-recorded crashes during the twelve-month follow-up period. State crash records did not agree with any other outcome measure. Those who scored 5 or less on the ORT were more likely to report a crash in the past five years (55.4% vs. 36.8%; p = .009). Results did not differ when participants with probable dementia were excluded (n = 2). The results suggest that caution should be applied when using state crash records as an outcome measure in driving research and suggest that in the Australian context, retrospective self-reported crashes over five years are preferable when objective measures of driving performance are unavailable.

Objectives: To compare the performance on a standardized driving evaluation of a group of oldest old adults (age 90-97) against younger old adults (age 80-87) and examine whether the same cognitive variables and brake reaction time performance were associated with pass-fail status on a road test in both groups. Secondary objectives focused on an examination of the specific driving errors of both groups. Methods: This retrospective cohort study was conducted in the setting of a clinical driving evaluation program at an academic medical center in the United States. In this study we examined the performance of 88 participants (27 age 90-97 and 61 age 80-87) who completed comprehensive driving evaluations between 1997 and 2011. The outcome variable was performance on a standardized road test. Measures included the Trail Making Test (TMT), the Mini Mental State Examination (MMSE), and brake reaction time (BRT). An exploratory analysis of the possible predictive value of specific MMSE subtests was also performed. Results: Results indicate that the oldest old adults (90-97 years old) were at no greater driving risk than were a younger old (80-87 years old) cohort and made similar types and frequency of driving errors. TMT-B time was associated with pass-fail status in both groups. MMSE attention items discriminated between safe and unsafe younger old drivers, and MMSE orientation items were associated with pass-fail status in the oldest old cohort. Conclusion: Drivers age 90 and above were at no greater driving risk than those one decade younger. MMSE orientation questions may be useful to assist in identifying which oldest old drivers could benefit from a comprehensive driving evaluation including an on-road test.

Objective: Young novice drivers' poor hazard perception (HP) skills are a prominent cause for their overinvolvement in traffic crashes. HP, the ability to read the road and anticipate forthcoming events, is receptive to training. This study explored the formation and evaluation of a new HP training intervention-the Act and Anticipate Hazard Perception Training (AAHPT), which is based upon exposing young novice drivers to a vast array of actual traffic hazards, aiming to enhance their ability to anticipate potential hazards during testing. Method: Forty young novices underwent one of 3 AAHPT intervention modes (active, instructional, or hybrid) or a control group. Active members observed video-based traffic scenes and were asked to press a response button each time they detected a hazard. Instructional members underwent a tutorial that included both written material and video-based examples regarding HP. Hybrid members received a condensed theoretical component followed by a succinct active component. Control was presented with a road safety tutorial. Approximately one week later, participants performed a hazard perception test (HPT), during which they observed other movies and pressed a response button each time they detected a hazard. Twenty-one experienced drivers also performed the HPT and served as a gold standard for comparison. Results: Overall, the active and hybrid modes were more aware of potential hazards relative to the control. Conclusions: Inclusion of an active-practical component generates an effective intervention. Using several evaluation measurements aids performance assessment process. Advantages of each of the training methodologies are discussed. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Safety belts are the most important safety system in motor vehicles and should always be worn to prevent serious injury. The purpose of this study, using Crash Injury Research Engineering Network (CIREN) data, was to assess occupant and crash factors associated with minor contusions and abrasions caused by the safety belt (commonly referred to as seat belt signs) and their association with serious intra-abdominal trauma. CIREN data were used to determine which factors are associated with seat belt signs. Occupant variables (age, gender, body mass index, proper safety belt use, driver v. passenger status) and crash variables (crash type, crash severity, and airbag deployment) were compared for occupants with seat belt sign who had serious (AIS 3 or greater) intra-abdominal injury and those who did not have intra-abdominal injuries. Adjusted odds ratios were used to quantify the independent association between predictive factors for serious intra-abdominal injury for occupants with seat belt signs. Of 1539 occupants included in this study, 419 had a positive seat belt signs. Of those 419 occupants, 100 had serious intra-abdominal injury and 319 did not. Being in the passenger seat position increased the odds, whereas front airbag deployment and frontal impact were associated with decreased odds of serious intra-abdominal injury for occupants with seat belt signs. However, multivariate analysis showed only that being a passenger increased the odds (OR = 2.64) of having serious intra-abdominal injury for occupants with seat belt signs when other factors, including crash severity and type of impact, were controlled for in the analysis. Seat belt signs remain an important physical finding in patients with intra-abdominal injury following motor vehicle crashes. Front seat passengers presenting with seat belt signs were more than twice as likely to sustain intra-abdominal injury; thus, emergency physicians and trauma surgeons should be aware of passenger position when evaluating a seat belt sign.

This pilot study aimed to verify the impact of the awareness tool for safe and responsible driving (OSCAR) on older adults' (1) interest, openness, and knowledge about the abilities and compensatory strategies required for safe driving; (2) awareness of changes that have occurred in their own driving abilities; and (3) actual utilization of compensatory strategies. A preexperimental design, including a pretest (T0) and posttest (T1) 8 to 10 weeks after exposure to the intervention, was used with 48 drivers aged between 67 and 84. The participants had a valid driving license and drove at least once a week. Overall, the results demonstrate that OSCAR increased interest, openness, and knowledge about the abilities and compensatory strategies of older drivers (P <.01). After exposure to OSCAR, the majority of the participants confirmed that changes had occurred in at least one of their abilities. Moreover, half of the older drivers reported having started using 6 or more compensatory strategies. In summary, in addition to increasing older adults' interest, openness, and knowledge to discussion about driving, OSCAR also improved awareness of the changes that could negatively impact safe driving and enhanced utilization of compensatory strategies. While promoting safe driving and the prevention of crashes and injuries, this intervention could ultimately help older adults maintain or increase their transportation mobility. More studies are needed to further evaluate OSCAR and identify ways to improve its effectiveness.

Objective: In this article, we review the impact of vision on older people's night driving abilities. Driving is the preferred and primary mode of transport for older people. It is a complex activity where intact vision is seminal for road safety. Night driving requires mesopic rather than scotopic vision, because there is always some light available when driving at night. Scotopic refers to night vision, photopic refers to vision under well-lit conditions, and mesopic vision is a combination of photopic and scotopic vision in low but not quite dark lighting situations. With increasing age, mesopic vision decreases and glare sensitivity increases, even in the absence of ocular diseases. Because of the increasing number of elderly drivers, more drivers are affected by night vision difficulties. Vision tests, which accurately predict night driving ability, are therefore of great interest. Methods: We reviewed existing literature on age-related influences on vision and vision tests that correlate or predict night driving ability. Results: We identified several studies that investigated the relationship between vision tests and night driving. These studies found correlations between impaired mesopic vision or increased glare sensitivity and impaired night driving, but no correlation was found among other tests; for example, useful field of view or visual field. The correlation between photopic visual acuity, the most commonly used test when assessing elderly drivers, and night driving ability has not yet been fully clarified. Conclusions: Photopic visual acuity alone is not a good predictor of night driving ability. Mesopic visual acuity and glare sensitivity seem relevant for night driving. Due to the small number of studies evaluating predictors for night driving ability, further research is needed.