Toward environments and policies that promote injury-free active living--it wouldn't hurt

Profile and risk factors in farmer injuries: a review based on Haddon matrix and 5 E's risk reduction strategy

Farmers are considered a high-risk group for intentional and unintentional injuries. This review identified significant risk factors for agricultural injuries in farmers and explored injury prevention countermeasures based on the literature. Therefore, CiteSpace software was used to analyze the relevant literature in this field. Additionally, we identified both key risk factors and countermeasures using the Haddon matrix and the 5 E's risk reduction strategies conceptual framework, respectively. The risk factors were identified from four categories (host, agent, physical environment, and social environment) corresponding to three phases (pre-event, event, and post-event). Interventions of 5 E's risk reduction strategies including education, engineering, enforcement, economic, and emergency response have been proven effective in preventing injuries or reducing their severity. Our findings provide a comprehensive foundation and research direction for the study and prevention of injuries among farmers.

Integrating complex systems science into road safety research and practice, part 1: review of formative concepts

Many of our most persistent public health problems are complex problems. They arise from a web of factors that interact and change over time and may exhibit resistance to intervention efforts. The domain of systems science provides several tools to help injury prevention researchers and practitioners examine deep, complex and persistent problems and identify opportunities to intervene. Using the increase in pedestrian death rates as an example, we provide (1) an accessible overview of how complex systems science approaches can augment established injury prevention frameworks and (2) a straightforward example of how specific systems science tools can deepen understanding, with a goal of ultimately informing action.

Safety of motorized two-wheeler riders in the formal and informal transport sector

Road fatalities are largely preventable problem with large socioeconomic impact. Due to the rapidly increasing population, transport systems and road infrastructure have not met the demand. The use of motorized two-wheeler vehicles has increased, as informal transport. However, evidence on their safety is scarce. The aim of this article is to examine the safety and social equity issues in MTW in the informal transport sector. Factors can be used to explain traffic collisions in MTW in the formal/informal transport sectors: design, rider behavior, road design, enforcement, and regulation of the informal transport sector. Evidence suggests that MTWs could be a common related to pedestrian fatalities. Informal transport drivers are typically poor, uneducated, young men who due to lack of other employment options move into the informal sector. Their vehicles are old, unmaintained and have a lack of protective equipment for themselves and their passengers. Young, male drivers speed, take risks and not use protective equipment. Users of informal transport live in the poorer peripheries of cities, which, have limited, inefficient or unaffordable public transport. The provision of transport has therefore become an often unrecognized, important social equity issue and studies are urgently needed on MTW in the informal transport sector.

Knowledge and Beliefs About Pedestrian Safety in an Urban Community: Implications for Promoting Safe Walking

As more people walk for transport and exercise, it is possible to avoid a concomitant increase in the number of pedestrian injuries. Understanding how the public views pedestrian safety can help inform the development of prevention strategies that support national efforts to promote walking and walkable communities. As part of the formative research for a community pedestrian safety health promotion campaign, we administered an online questionnaire to employees and students at a large urban medical campus, along with residents in the neighboring communities, to determine their knowledge, attitudes, and behavior regarding pedestrian safety; awareness of relevant traffic safety laws; and effective strategies that could improve pedestrian safety. Pearson Chi square Test of Independence was used to investigate differences between individuals who mainly traveled as drivers versus those who mainly traveled as pedestrians. Statistical significance was established at p < .05. A total of 3808 adults completed the online survey. More drivers than pedestrians reported that pedestrian safety was an important problem (73 and 64%, respectively; p < .001). A large proportion of respondents incorrectly reported the existing state laws addressing right of way, fines, and enforcement, with significant differences between drivers and pedestrians (p < .001). Significantly more pedestrians than drivers supported changing traffic signals to increase crossing time (p = .001), while more drivers than pedestrians supported creating structures to prevent midblock crossing (p = .003). Effective interventions to improve pedestrian safety need to tailor messages for both drivers and pedestrians, increase awareness of the laws, and implement comprehensive strategies.

Drowning mortality by intent: a population-based cross-sectional study of 32 OECD countries, 2012-2014

OBJECTIVE

To compare the drowning mortality rates and proportion of deaths of each intent among all drowning deaths in Organisation for Economic Co-operation and Development (OECD) countries in 2012-2014.

DESIGN

A population-based cross-sectional study.

SETTING

32 OECD countries.

PARTICIPANTS

Individuals in OECD countries who died from drowning.

MAIN OUTCOME MEASURES

Drowning mortality rates (deaths per 100 000 population) and proportion (%) of deaths of each intent (ie, unintentional intent, intentional self-harm, assault, undetermined intent and all intents combined) among all drowning deaths.

RESULTS

Countries with the highest drowning mortality rates (deaths per 100 000 population) were Estonia (3.53), Japan (3.49) and Greece (2.40) for unintentional intent; Ireland (0.96), Belgium (0.96) and Korea (0.89) for intentional self-harm; Austria (0.57), Korea (0.56) and Hungary (0.44) for undetermined intent and Japan (4.35), Estonia (3.70) and Korea (2.73) for all intents combined. Korea ranked 12th and 3rd for unintentional intent and all intents combined, respectively. By contrast, Belgium ranked 2nd and 15th for intentional self-harm and all intents combined, respectively. The proportion of deaths of each intent among all drowning deaths in each country varied greatly: from 26.2% in Belgium to 96.8% in Chile for unintentional intent; 0.7% in Mexico to 57.4% in Belgium for intentional self-harm; 0.0% in nine countries to 4.9% in Mexico for assault and 0.0% in Israel and Turkey to 38.3% in Austria for undetermined intent.

CONCLUSIONS

A large variation in the practice of classifying undetermined intent in drowning deaths across countries was noted and this variation hinders valid international comparisons of intent-specific (unintentional and intentional self-harm) drowning mortality rates.

Effects of speed-control measures on the safety of unsignalized midblock street crossings in China

OBJECTIVE

The primary objective of this study was to evaluate the effects of different speed-control measures on the safety of unsignalized midblock street crossings.

METHODS

In China, it is quite difficult to obtain traffic crash and conflict data for pedestrians using such crossings, mainly due to the lack of traffic data management and organizational issues. In light of this, the proposed method did not rely on such data, but considered vehicle speed, which is a leading contributing factor of pedestrian safety at mid blocks. To evaluate the speed reduction effects at different locations, the research team utilized the following methods in this study: (1) testing speed differences-on the basis of the collected data, statistical analysis is conducted to test the speed differences between upstream and crosswalk, upstream and downstream, and downstream and crosswalk; and (2) mean distribution deviation-this value is calculated by taking the difference in cumulative speed distributions for the two different samples just mentioned. In order to better understand the variation of speed reduction effects at different distances from speed-control facilities, data were collected from six types of speed-control measures with a visual range of 60 m.

RESULTS

The results showed that speed humps, transverse rumble strips, and speed bumps were effective in reducing vehicle speeds. Among them speed humps performed the best, with reductions of 21.1% and 20.0% from upstream location (25.01 km/h) and downstream location (24.66 km/h) to pedestrian crosswalk (19.73 km/h), respectively. By contrast, the speed reduction effects were minimal for stop and yield signs, flashing yellow lights, and crossings without treatment.

CONCLUSIONS

Consequently, in order to reduce vehicle speeds and improve pedestrian safety at mid blocks, several speed-control measures such as speed humps, speed bumps, and transverse rumble strips are recommended to be deployed in the vicinity of pedestrian crosswalks.

The Relationship Between Objectively Measured Walking and Risk of Pedestrian-Motor Vehicle Collision

Safe urban walking environments may improve health by encouraging physical activity, but the relationship between an individual's location and walking pattern and the risk of pedestrian-motor vehicle collision is unknown. We examined associations between individuals' walking bouts and walking risk, measured as mean exposure to the risk of pedestrian-vehicle collision. Walking bouts were ascertained through integrated accelerometry and global positioning system data and from individual travel-diary data obtained from adults in the Travel Assessment and Community Study (King County, Washington) in 2008-2009. Walking patterns were superimposed onto maps of the historical probabilities of pedestrian-vehicle collisions for intersections and midblock segments within Seattle, Washington. Mean risk of pedestrian-vehicle collision in specific walking locations was assessed according to walking exposure (duration, distance, and intensity) and participant demographic characteristics in linear mixed models. Participants typically walked in areas with low pedestrian collision risk when walking for recreation, walking at a faster pace, or taking longer-duration walks. Mean daily walking duration and distance were not associated with collision risk. Males walked in areas with higher collision risk compared with females, while vehicle owners, residents of single-family homes, and parents of young children walked in areas with lower collision risk. These findings may suggest that pedestrians moderate collision risk by using lower-risk routes.

Do healthier lifestyles lead to less utilization of healthcare resources?

Background

Governments are urged to determine methods to control the use of medical resources and curb the rise of healthcare costs. The question is, do health behaviors have an impact on the use of medical resources? This study aims to identify and understand the difference in the number of outpatient visits and health examinations based on various health behaviors and to determine whether patients seek medical care for illness from the same physicians.

Methods

This study used the dataset derived from the Department of Budget, Accounting and Statistics of Kaohsiung, Taiwan in 2005. Persons older than 15 years were surveyed using an on-site questionnaire. A total of 2911 persons were enrolled in this study. Independent t-tests, chi-square tests, one-way ANOVA, multiple linear regression and binominal logistic regression were used in the data analysis.

Results

The regression model for the frequency of doctor visits, health examinations, and whether the same physician is sought for medical care has demonstrated significant correlations with gender, age and education-level variables. Four health behaviors (i.e., exercise habits, dietary habits, regular blood pressure measurement, drinking habits) exhibited a significant correlation with healthcare utilization (P <0.05).

Conclusions

Healthy lifestyles lead to an increase in the utilization of preventive health services. However, there is not much significantly reducing the number of outpatient visits in people with health behaviors. Specifically, people with regular exercise habits and who take their blood pressure measurement regularly have an increased number of outpatient visits. It is suggested that more available and accessible health consultation services be provided to inculcate in the general public the importance of maintaining a healthy lifestyle.

Breaking Out of Surveillance Silos: Integrative Geospatial Data Collection for Child Injury Risk and Active School Transport

The preponderance of active school transport (AST) and child injury research has occurred independently, yet they are inherently related. This is particularly true in urban areas where the environmental context of AST may pose risks to safety. However, it can be difficult to make these connections due to the often segregated nature in which these veins of research operate. Spatial video presents a geospatial approach for simultaneous data collection related to both issues. This article reports on a multi-sector pilot project among researchers, a children's hospital, and a police department, using spatial video to map child AST behaviors; a geographic information system (GIS) is used to analyze these data in the environmental context of child pedestrian injury and community violence.

Preventing Child Pedestrian Injury: A Guide for Practitioners

Each year, an estimated 270,000 pedestrians die from road traffic-related injuries, (worldwide) and children are among the most vulnerable. Child pedestrian injuries occur primarily in residential areas, often on the same street or in close proximity to the child's home, and 90% of injured child pedestrians are unaccompanied by an adult at the time of the injury. The cause of these injuries is a complex combination of factors related not only to characteristics of the child but also the built environment, the road configuration, features of the motor vehicle that might reduce injury, and driver behavior. Accordingly, effective interventions must incorporate education, technology, and improved infrastructure. The medical practitioner can not only provide the necessary education but can also be a powerful voice for changes in pedestrian infrastructure that make walking safer. This article explores the current state of childhood pedestrian injuries using examples from the United States and Australia. Pedestrian interventions and the role that primary care and lifestyle practitioners play in promoting safe pedestrian behaviors among their patients and their families are discussed.

Building safety into active living initiatives

OBJECTIVE

Efforts to promote environmental designs that facilitate opportunities for physical activity should consider the fact that injuries are the leading cause of death for Americans ages 1 to 44, with transportation-related injuries the most common cause. Drawing on the latest research and best practices in the field of injury prevention, the purpose of this article is to provide those working to promote physical activity with evidence-based recommendations on building in safety while designing active environments.

METHOD

A systematic review of the peer-reviewed and grey literature published from 1995 to 2012 was conducted to identify injury prevention strategies applicable to objectives in the Active Design Guidelines (ADG), which present design strategies for active living. Injury prevention strategies were rated according to the strength of the research evidence.

RESULTS

We identified 18 urban design strategies and 9 building design strategies that promote safety. Evidence was strong or emerging for 14/18 urban design strategies and 7/9 building design strategies.

CONCLUSION

ADG strategies are often wholly compatible with well-accepted injury prevention principles. By partnering with architects and planners, injury prevention and public health professionals can help ensure that new and renovated spaces maximize both active living and safety.

The walking environment in Lima, Peru and pedestrian-motor vehicle collisions: an exploratory analysis

OBJECTIVE

Pedestrians comprise 78% of the road fatalities in Peru. The objective of this study was to explore the relationship between the walking environment and pedestrian-motor vehicle collisions.

METHODS

A matched case-control study was used to detect the odds of a pedestrian-motor vehicle collision at a pedestrian crossing location. Data were collected from 11 sampled police commissaries in Lima, Peru.

RESULTS

In a multivariable model adjusting for vehicle and pedestrian flow, pedestrian collisions were less likely in the presence of a curb and sidewalk on both roadway sides (odds ratio [OR] = 0.19, 95% confidence interval [CI], 0.11-0.33) or a pedestrian barricade (OR = 0.11, 95% CI, 0.01-0.81). There was a greater risk of collisions for each street vendor present (OR = 2.82, 95% CI, 1.59-5.00) or whether any parked vehicles (OR = 3.67, 95% CI, 1.18-11.4) were present.

CONCLUSIONS

Improving or addressing these potentially modifiable features of the walking environment could improve pedestrian safety in Lima and in similar urban settings in low- and middle-income countries.

Overcoming legal liability concerns for school-based physical activity promotion

Schools have been identified as a priority environment for physical activity promotion as a component of efforts to help prevent childhood obesity. A variety of school-based environmental and programmatic strategies have been proven effective in promoting physical activity both on-site and in the surrounding community. However, many schools are deterred by fears of increased risk of legal liability for personal injuries. We examine 3 school-based strategies for promoting physical activity--Safe Routes to School programs, joint use agreements, and playground enhancement--from a tort liability perspective, and describe how schools can substantially minimize any associated liability risk through injury prevention and other strategies. We also recommend approaches to help schools overcome their liability concerns and adopt these critically needed healthy school policies.

The health effects of motorization

Kavi Bhalla provides a perspective on new research by Christopher Millett and colleagues that reports rural dwellers who migrate to cities have worse cardiovascular outcomes, partly due to a shift to private motor vehicles and reduced physical activity. Please see later in the article for the Editors' Summary

Environmental determinants of bicycling injuries in Alberta, Canada

This study examined environmental risk factors for bicycling injuries, by combining data on bicyclist injuries collected by interviews in the emergency department (ED) with street-level environmental audits of injury locations, capturing path, roadway, safety, land use, and aesthetic characteristics. Cases were bicyclists struck by a motor vehicle (MV) or with severe injuries (hospitalized). Controls were bicyclists who were not hit by a car or those seen and discharged from the ED, matched on time and day of injury. Logistic regression odds ratios (ORs) adjusted for age, sex, peak time, and bicyclist speed with 95% confidence intervals (CIs) were estimated to relate injury risk to environmental characteristics. Factors contributing to MV events included greater traffic volume (OR 5.13; 95% CI [1.44, 18.27]), intersections (OR 6.89; 95% CI [1.48, 32.14]), retail establishments (OR 5.56; 95% CI [1.72, 17.98]), and path obstructions (OR 3.83; 95% CI [1.03, 14.25]). Locations where the road was in good condition (OR 0.25; 95% CI [0.07, 0.96]) and where there was high surveillance from surrounding buildings (OR 0.32; 95% CI [0.13, 0.82]) were associated with less severe injuries. These findings could be used by bicyclists and transportation planners to improve safety.