Exposure-based cycling crash, near miss and injury rates: The Safer Cycling Prospective Cohort Study protocol

Abstract

There are clear personal, social and environmental benefits of cycling. However, safety concerns are among the frequently cited barriers to cycling. In Australia, there are no exposure-based measures of the rates of crash or 'near miss' experienced by cyclists.
A prospective cohort study over 12 months, with all data collected via web-based online data entry.
Two thousand adults aged 18 years and older, living in New South Wales (Australia), who usually bicycle at least once a month, will be recruited from March to November 2011.
In the 12 months following enrolment, cyclists will be surveyed on six occasions (weeks 8, 16, 24, 32, 40 and 48 from the week of the enrolment survey). In these survey weeks, cyclists will be asked to provide daily reports of distance travelled; time, location and duration of trips; infrastructure used; crashes, near misses and crash-related injuries. Information on crashes and injuries will also be sought for the intervening period between the last and current survey. A subsample of participants will receive bicycle trip computers to provide objective measurement of distance travelled.
This study protocol describes the prospective cohort study developed to assess near misses, crashes and injuries among cyclists by time and distance travelled and by type of infrastructure used, with recruited participants entering data remotely using the internet. We expect to be able to calculate event rates according to exposure overall and for different infrastructure types and to report in-depth information about event causation.

Full text

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Exposure‐basedcyclingcrash,nearmissandinjuryrates:TheSaferCyclingProspectiveCohort
Studyprotocol

Authors
RoslynG.Poulos1
JulieHatfield2,
ChrisRissel3
RaphaelGrzebieta2
AndrewSMcIntosh4
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Affiliationsandcontactdetails
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1SchoolofPublicHealthandCommunityMedicine,TheUniversityofNewSouthWales,Sydney
2052,Australia.
2TransportandRoadSafety(TARS)Research,TheUniversityofNewSouthWales,Sydney,New
SouthWales,Australia.
3SchoolofPublicHealth,SydneyMedicalSchool,UniversityofSydney,Sydney,Australia.
4RiskandSafetyScience,TheUniversityofNewSouthWales,Sydney,NewSouthWales,Australia.
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Correspondenceto
RoslynGPoulos,SchoolofPublicHealthandCommunityMedicine,TheUniversityofNewSouth
Wales,Sydney2052,Australia;r.poulos@unsw.edu.au
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Exposure‐basedcyclingcrash,nearmissandinjuryrates:TheSaferCyclingProspectiveCohort
Studyprotocol

Abstract

Introduction:Thereareclearpersonal,socialandenvironmentalbenefitsofcycling.However,
safetyconcernsareamongthefrequentlycitedbarrierstocycling.InAustralia,thereareno
exposure‐basedmeasuresoftheratesofcrashor‘nearmiss’experiencedbycyclists.

Designandsetting:Aprospectivecohortstudyover12months,withalldatacollectedviaweb‐
basedonlinedataentry.

Participants:Twothousandadultsaged18yearsandolder,livinginNewSouthWales(Australia),
whousuallybicycleatleastonceamonth,willberecruitedfromMarchtoNovember2011.

Methods:Inthe12monthsfollowingenrolment,cyclistswillbesurveyedon6occasions(weeks8,
16,24,32,40,and48fromtheweekoftheenrolmentsurvey).Inthesesurveyweeks,cyclistswillbe
askedtoprovidedailyreportsofdistancetravelled;time,locationanddurationoftrips;
infrastructureused;crashes,nearmissesandcrash‐relatedinjuries.Informationoncrashesand
injurieswillalsobesoughtfortheinterveningperiodbetweenthelastandcurrentsurvey.A
subsampleofparticipantswillreceivebicycletripcomputerstoprovideobjectivemeasurementof
distancetravelled.

Discussion:Thisstudyprotocoldescribestheprospectivecohortstudydevelopedtoassessnear
misses,crashesandinjuriesamongcyclistsbytimeanddistancetravelledandbytypeof
infrastructureused,withrecruitedparticipantsenteringdataremotelyusingtheinternet.Weexpect
tobeabletocalculateeventrateaccordingtoexposureoverallandfordifferentinfrastructuretypes
andtoreportin‐depthinformationabouteventcausation.

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Exposure‐basedcyclingcrash,nearmissandinjuryrates:TheSaferCyclingProspectiveCohort
Studyprotocol

Background
Thereareclearpersonal,socialandenvironmentalbenefitsofcycling.Thesebenefitsincreaseas
individualscyclemoreandasmorepeoplecycle.[1]Personalbenefitsofrecreationalortransport
cyclingincludesubstantialhealthgains,[2]withasignificantreductioninall‐causemortalityand
cardiovascularrisk.[3,4]Cyclingmayalsobeanimportanttoolinthefightagainsttheobesity
epidemic,withecologicalstudiesnotinglowerratesofobesityinregionswithhighratesof
cycling.[5]ThevalueofcurrentcyclingtotheAustralianhealthsystemhasbeenconservatively
estimatedat$227millionperannum.[1]

Cycling,andurbanenvironmentsthatsupportcyclingandwalkinganddiscouragecaruse,can
improvesocialinteractionsandincreasecommunityattachment,liveabilityandamenity.[6]Thereis
alsoevidencethatthemorecompact,permeableurbandesignsthatsupportcyclingandwalking
leadtocrimereductionthroughincreasedstreetactivityand‘naturalsurveillance’.[7]

Wherecyclingreplacesamotorvehicletripthereareenvironmentalbenefits,suchasreduced
carbondioxideemissionsandotherpollutants.[1]Additionally,anincreaseintransportcyclingmay
easetrafficcongestion,reducemotorvehiclecrashesandthuspotentiallyreduceroadtrauma
costs.[8]

ThetransportationcyclingrateinAustraliaislowcomparedtootherdevelopedcountriessuchas
theNetherlands,DenmarkorGermany.[5]Countrieswithhighcyclingratestendtohavebetter
cyclingfacilities,effectivetrafficcalmingmeasuresandwell‐developedcyclinginfrastructure,
cycling‐friendlyurbandesign,restrictionsonmotorvehicleuseandcomprehensivetrafficeducation
abouthowtointeractwithcyclists.[9]

Cycling‐specificinfrastructureisgenerallyrecognisedasanecessarystartingpointtoattractnew
non‐cycliststocycling.[1]However,itisnotalwaysclearwhattypeofinfrastructurewillproducethe
maximaladoptionofcyclingwiththegreatestsafetybenefits.Forexample,introducingshared‐use
pathsforpedestriansandcyclistsmaydecreasecyclistcrashrateswithmotoristsbutcouldincrease
pedestrianinjuryrates.[10]
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SignificantnumbersofcyclistsarekilledorseriouslyinjuredinAustraliaeveryyear,andthese
numbersappeartobeincreasing.Morethan15000bicyclistswereinvolvedinpolicereported
crashesintheAustralianstatesofVictoria,Queensland,SouthAustralia,andWesternAustralia
during2000‐2004,[11]andthereweremorethan2000motor‐vehicle‐relatedcrashesleadingto
hospitalisationsinbicyclistsinthestateofNewSouthWalesbetween1999/2000and2004/2005.
[12]Further,itislikelythatthesedataunderenumeratetheproblembecausemanylessserious
cyclingincidentsgounreportedtopolice,orbecausethedatadonotincludedeathsandinjuries
arisingfromfallsandcollisionsnotinvolvingmotorvehiclesanddonotincludecasualtiesreceiving
outpatienttreatment.RecentlypublisheddatafromVictoriareportsasignificantincreasein
emergencydepartmentandhospitaladmissionsforbicycleinjuriesfrom2001to2006andamarked
increaseinthenumberofcyclistssustainingsevereinjury.[13]However,theinterpretationofthese
dataisseverelylimitedbythequalityofdataintermsofcyclingexposureandcontributing
factors.[13,14]

Toreducetherisksassociatedwithcyclistssharingtrafficlaneswithmotorvehicles,strategiessuch
asbicyclelanes(i.e.,portionsoftheroadwaydesignedfortheuseofbicycles)andbicyclepaths(a
physicallyseparatepathwayforbicyclesorashared‐usepathforbicyclesandpedestrians)have
beenbuilt.Therelativemeritsofthesedifferentstrategiesremaindebated,especiallyinurbanareas
inmajorcities,wherethisquestionisimportantduetolimitedavailabilityoflandandfinance.
Researchduringthe1970sintheUSAindicatedthatbicyclelanesmayhaveaprotectiveeffectfor
mostcollisiontypes,butanincreasedriskforcollisionsoccurringwhenthecyclistturnsleftinto
traffic(turningrightinAustralia).[15]Laterresearchfoundthattheriskofridingonthesidewalk
(includingbicyclepathsandfootpaths)washigherthantheriskofridingontheroadway,probably
becauseofblindconflictsatintersections.[16]EarlyresearchfromEnglandreportedthattherateof
injurywasgreateroncyclewayscomparedtolocalroadsandgridroads,butprimarilybecauseof
poordesignincludingvisibilityproblems,especiallyatintersections,sharpbends,steepgradients,
slipperybridges,loosegravelandmud.[17]Otherrisksincludedhead‐oncrashesbetweencyclists,
collisionswithdogs,andeyeinjuriesfromintrudingvegetation.[17]Thecontestednatureofthe
evidencesupportingvariousinfrastructuresolutionshasledforcallsintheinternationalliterature
formoreresearcharoundinfrastructureandforimprovedunderstandingaboutbehaviour,safety
andsafetyperception.[18]

Ifcyclingistobeencouragedasahealth‐promotingpractice,orasasustainableformoftransport,
thenitisincumbentonauthoritiestoprovideanenvironmentthatminimisesrisk,tomanagepublic

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perceptionofriskandtopromotetheactivityappropriately.However,becauseofthelackof
exposuredatainAustralia,[13]actualcrashandinjuryratesrelatedtodistancecycled,durationof
travelorinfrastructureusedareunknown.

CyclingisbeingactivelypromotedbytheAustralianhealthandtransportsectorsandbygovernment
atalllevels,[19‐21]andinfrastructureisbeingprogressivelydevelopedacrossthecountry.
However,thereisverylittleknowledgeonwhichtobasedecisionmaking.Thisprojectistherefore
significantbecauseitmeetsanurgentandrapidlyincreasingdemandforevidencetosupportpolicy.

Thisstudyaimsto:
1. Developmeasuresofcyclistcrash,nearmissandinjuryratesforabroadlyrepresentative
populationofcyclistsfrommetropolitanandregionalNewSouthWales
2. Identifyfactorsthatcontributetocrash,nearmissandinjuryrates,forexample,human
factorsandroadenvironment.
3. Assesstherisksforcyclistsassociatedwithcyclingonroads,bicyclelanesandpaths.
4. Describethetype,locationandfrequencyofhazardsidentifiedbycyclists.

Methods

Overallstudydesign:Acohortstudyoftwothousandcyclists(18yrsandover)whoresideinNew
SouthWalesandrideatleastoncepermonthwillbeundertaken.Cyclistswillberecruitedvia
multiplechannelsincludingtheextensiveemaillistsofBicycleNSW(astatecyclingadvocacy
organisation),arangeofcommunitycyclingevents,bikeshops,mediapublicityandthroughwordof
mouthwithinthecyclingcommunity.Participantswillenrolandcompletethebaseline
questionnaireandallsubsequentfollow‐upquestionnairesviaasecurewebsite.Automatically
generatedemailsplusSMStextmessages(forthosewhoselecttextreminders)willbesentto
participantswhenfollow‐upquestionnairesaredueforcompletion.

Toincreasethelikelihoodofaccuratemeasurementofdistancesandtimetravelled,bicycletrip
computerswillbeofferedtoasubsetofenrolledcyclistswhorideatleastonceperweekandwho
reportnothavingtheirowntripcomputersonenrolment.Toensurethemosteffectiveuseof
limitedresources,cyclistswillnotbeofferedtripcomputersiftheyhavemorethanonebikeanddo
notidentifyridingonebikeatleast90%ofthetime,iftheirmainbikeisaBMXbikeas‘offroad’
cyclingisoutsidetheprimaryaimofthestudyoriftheirmainbikeisclassifiedas‘other’andmay

6
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notbecompatiblewiththebicycletripcomputer(e.g.,folding,recumbentorelectricbikes).
Participantswishingtoaccepttheofferofatripcomputerwillbeaskedtosupplythedataontyre
sizefromthewalloftheirbicycletyreandthediameteroftheirwheel.Tripcomputersare
individuallyprogrammedbyresearchstaffusingthetyrecircumferencereferencetableor
calculationinstructionssuppliedbythemanufacturer.Tripcomputerswiththemanufacturer’s
installationinstructionswillbesentbyposttoparticipants.Bicycletripcomputerswillbeoffered
untilresearchstocksareexhausted(estimatedtobearound400computers).

Pilottesting:Paperversionsofthequestionnaireswerepilotedwithcolleagueswhocycle(within
theUniversityandfundingpartnerorganisations)andmodifiedaccordingly.Electronicversions
wereagaintestedwithcolleagueswhocycle,priortoimplementation.

Baselinedatacollection:Atenrolment,demographicdata(e.g.,age,gender,education,
employmentstatus,income,drivinglicence,caraccess),cyclingexperienceandconfidence,self‐
identificationofcyclisttype(transportorrecreational),usualcyclinghabits(averagemonthly
distanceandhourscycled,useofinfrastructureandcyclingequipmentoverpast12months),history
ofcrashesandcrash‐relatedinjuriesoverthelast12months,andattitudestoriskandsensation
seeking(usingpreviouslyvalidatedinstruments[22,23])willbecollected.

Follow‐updatacollection:Overthe12monthsfollowingenrolment,therewillbe6surveyweeks
(weeks8,16,24,32,40,and48fromtheweekofthebaselinesurvey).Atthestartofeachsurvey
week,participantswillbeaskedaboutcrashesandcrash‐relatedinjuriesfortheinterveningperiod
betweenthelastandcurrentsurvey,andthentocompleteatraveldiaryfortheensuing7days.
Cyclistswillbeaskedtoprovidedailyreportsofdistancetravelled;time,locationanddurationof
trips;infrastructureused;crashes,nearmissesandcrash‐relatedinjuriesexperienced.Toenablethe
calculationofrates,participantswithbiketripcomputerswillbeaskedtoprovidereadingsfromthe
computer,whileotherparticipantswillestimatetimeanddistancestravelled.Cyclistsmayenter
dataviathesecurewebsiteonadailybasis,orkeepahardcopyrecordoftheirtripsbyprinting
downa7‐dayPDFversionofthediary,andenteringtheirdataattheendoftheweek.

Ateachsurvey,severaladditionalquestionsonaspectsofcyclingwillbeasked.Thesewillinclude
aggressionexperiencedwhilecyclingwithotherroadusers(follow‐upperiod1);infrastructure
preferencesandconcerningsafetyissues(follow‐upperiod2);cyclingactivitiesandbeliefsinrespect

7

ofsafety(follow‐upperiod3);observationoftheroadrulesandlawsforcyclists(follow‐upperiod
4);cyclingfortransport(follow‐upperiod5);andcyclingwithchildren(follow‐upperiod6).

Duringeachfollow‐upperiod,participantswillreceivereminderemails(oneonthedaypriortothe
commencementofthereportingperiod,ondays2to7andafinalreminderemailonday8).The
computerprogrammingallowsfor7consecutivedaysofreportingwithina14‐daywindow,after
whichaccesstothefollow‐upquestionnaireisblocked.Thisflexibilitywillallowcycliststhe
opportunityofcommencingtheirdiaryupto7daysafterthestartdateandstillcollecttheirdata
prospectively(e.g.,incaseswherecyclistsdonotaccesstheiremaildailyandthereforereceivelate
notificationoftheirstartdate)ortoallowsomeflexibilityinthenumberofdaysavailableinwhich
datacanbeenteredforthosecyclistswhohavekeptahardcopydiary.

Qualitativedatacollectionfollowingcrashreports:Allcyclistsreportingacrashoccurringduring
theirreportingweekwillbecontactedbytelephonetoansweradditionalquestionsaboutthe
locationoftheevent,thecircumstancesleadingtotheevent,behaviouralorenvironmentalrisk
factors,injuriessustained(type,severityandtreatment),andsuggestedwaysinwhichtheevent
couldhavebeenprevented.

Definitions:Crashesaredefinedascollisionsorfalls,basedonthedefinitionsgiveninthereviewby
Reynoldsetal(2009).[24]Acollisionisdefinedasaneventinwhichthebicyclehitsorishitbyan
object,personoranimal,regardlessoffault;andafallisdefinedasanevent(notcausedbya
collision)wherethebicycleand/orbikeriderlandsontheground.

Anearmissisdefinedasanunexpectedeventwhilecyclingthatcausesthecyclistoranotherparty
totakesuddenevasiveaction,andwithoutsuchactionthecyclistbelievesacrash(collisionorfall)
wouldhavehappened.

Forclarity,participantswillbeprovidedwithimagesanddefinitionsofallrelevantcycling
infrastructure,asshowninfigure1.






8


Figure1Cyclinginfrastructuredefinitions.


Planneddataanalysis:Quantitativedataanalysiswillincludebasicdescriptiveanalysisofthe
baselineandfollow‐updataandacalculationofeventrates.Eventrateswillbecalculatedusingthe
incidentnumberofevents(collision,fallsornearmisses)perhoursofcyclingorkilometrestravelled.
Theincidencerateofcrasheswillalsobecalculatedfordifferentformsofinfrastructure.
Multivariablegeneralisedlinearmodellingwillbeusedtoexplorehumanfactors(cyclist
characteristicssuchascyclingexperience,attitudesandbehaviour)aspredictorsofoutcome(event
rate).

Qualitativedatawillbeanalysedusing‘templateanalysis’.[21]Thismethodinvolvesthe
developmentofacodingtemplateorframeworkcomposedofcodesrepresentingthemesidentified
inthedatathroughmultiplereadingsofthetext.


Discussion
Thisstudyprotocoldescribesanoriginalresearchplanthatwillenablethecalculationofratesof
crashes,nearmissesandinjuriesrelatingtotimeanddistancecycledandthetypeofinfrastructure
usedforcycling.Thedeterminationofexposure‐basedrateswillmakeasignificantcontributionto
knowledgeaboutcyclinginAustralia,astheonlymeasurescurrentlyavailablearebasedon‘per
head’ofpopulation.[13].Itwillalsoallowcomparisonsofcyclingrisktoothertravelmodesin
Australiaandinternationally.Additionalquestionsaboutcyclingexperience,attitudesand
behaviourwillenabletheexplorationofthesevariablesaspredictorsofoutcome.Thestudywillalso
helptoanswerquestionswhicharedebatednationallyandinternationallyaroundtherelativemerit
ofdifferentformsofinfrastructure.Inaddition,wewillrecordcrashesandinjuriesthatarenot
capturedintheavailabledatacollections,suchascrasheswhicharenotreportedtopoliceor
injurieswhichdonotrequirehospitalisation.Capturingqualitativeandquantitativedataonthese

9

crasheswillprovideagreaterunderstandingofthesurroundingcircumstancesandislikelytomeet
theneedforadditionalinformationonsingle‐vehiclebicyclecrashes.[25]Itwillenableustobetter
understandcyclingriskandtoprovideevidencetosupportabest‐practicesystemofcycling
infrastructureandeffectivepubliceducation.Thisshouldhelptopromotebettermanagementof
interactionsbetweenallusersoftransportfacilitiesinthefuture.

Strengthsandlimitations
Thisstudyisunique.Toourknowledge,itisthefirsttomeasureexposure‐basedratesofcrashes,
nearmissesandcrash‐relatedinjuriesforcyclistsinAustralia.Itwillbeconductedcompletely
online,supportedbyavarietyofonlineengagementandinteractionactivitiessuchastheSafer
CyclingStudyFacebookpage,aYouTubeclipaboutthestudyandregularemailand/ortextmessage
phonereminderstostudyparticipants.Thesearedesignedtomaintaincohortparticipationthrough
alldatacollectionstages.Inaddition,allcrashesrecordedindailyreportswillbefollowedupby
interviewtoexploreaspectsofthecrashthatarenotelicitedbythequantitativequestionsandto
provideacontextualunderstandingofthecrashevent.Finally,theprospectivenatureofthestudy
isexpectedtoreducerecallbias,andtheuseofbicycletripcomputersshouldreducemeasurement
error.

Thestudyislikelytohaveanumberoflimitations.Theseincludethepotentialforvolunteerandself‐
reportbias.Losstofollow‐upisalsolikely.However,asparticipantshavebeenaskedtosupplya
numberofdifferentcontactoptions(includingthoseofafriendorfamilymember),weexpecttobe
abletoidentifyparticipantsinwhomlosstofollow‐uphasbeentheresultofaseriouscycling‐
relatedinjury.


Acknowledgements
WethankDrSusanneMurphyforherassistanceinpreparingthismanuscriptforpublicationandthe
representativesfromourfundingpartnerorganisationswhohavecontributedtodevelopmentand
implementationofthisstudy.

Funding
ThisprojecthasbeenfundedundertheAustralianResearchCouncil’sLinkageProjectsfunding
scheme(projectnumberLP1000100597)withfinancialcontributionsfromtheRoadsandTraffic

10

AuthorityofNewSouthWales,SydneySouthWestAreaHealthService,BicycleNSWandWilloughby
Council.

References
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