Cross-sectional study of road accidents and related law enforcement efficiency for 10 countries: A gap coherence analysis

Socio-cultural context of road safety in youth: a scoping review

Road traffic injuries (RTIs) are a leading cause of death globally, disproportionately affecting youth in low- and middle-income countries (LMICs). While behavioral factors significantly contribute to RTIs, the role of socio-cultural norms remains understudied. This scoping review examines 75 studies (2000-2020) to explore how social norms (descriptive, injunctive, subjective, and collective) and cultural factors influence road safety behaviors among young people. Findings reveal that norms shape behaviors such as risky driving, helmet/seatbelt use, and compliance with traffic laws, often moderated by cultural contexts like gender, media, and religion. Peer and familial influences emerged as both risk and protective factors, while collective norms in certain communities reinforced harmful practices like drunk driving. Gaps persist in understanding the interplay between culture and norms, particularly in LMICs. The review highlights the need for culturally tailored interventions and further research to address socio-cultural determinants of road safety.

A cross-sectional safety evaluation approach using generalized extreme value models: A case of right-turn safety treatment

There has been an increase in the use of the extreme value theory (EVT) approach for conflict-based crash risk estimation and its application such as conducting the evaluation of safety countermeasures. This study proposes a cross-sectional approach for evaluating the effectiveness of a right-turn safety treatment using a conflict-based EVT approach. This approach combines traffic conflicts of different sites at the same period and develops the generalized extreme value (GEV) models. It introduces treatment as a dummy variable for estimating the treatment effects and adds traffic-related and conflict severity-related variables to account for unobserved confounding factors between sites. The approach was applied to a case of right-turn safety treatment at two signalized intersections in Nanjing, China. Conflict indicators (i.e., TTC, PET) and potential influencing factors of E-bike-heavy vehicle (EB-HV) right-turn interactions were extracted from aerial video data. A series of GEV models were developed considering different combinations of covariates and their link to the model parameters. Moreover, site GEV models were developed separately for each site to compare the treatment effects across different models. Based on the best-fit models, the results indicate significant safety improvements after implementing the right-turn safety treatment. In addition, the results also show that the cross-sectional GEV models indicate a significant reduction in the number of high-severity conflicts and lowering overall crash risk attributed to the treatment highlighting the applicability of the GEV cross-sectional models in evaluation safety treatments.

Protective effect of helmet use on mortality in bicycle crashes: A matched case-control study

INTRODUCTION

In 2022; South Korea had 3.3 million daily bicycle users and around 13,000 crashes with 190 fatalities annually. While helmets are known to prevent head injuries, research on their effectiveness in preventing fatalities is lacking. This study explores factors influencing bicycle-related fatalities and examines if helmets reduce the risk of death in road traffic incidents.

METHODS

This case-control study used data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) from 2011 to 2021; analyzing 76,983 bicycle injury cases. Of these, 282 fatalities were identified as the case group, and 1,112 controls were randomly selected based on gender, age, and year of visit. The study examined risk factors for bicycle fatalities and used conditional logistic regression to assess the impact of helmet use on traumatic brain injury and in-hospital mortality.

RESULTS

In this study of 1,394 patients (282 cases and 1,112 controls), 11.1% were wearing helmets at the time of the crash. The majority of cases involved males (88%) and individuals aged 60-79 years (58.6%). Cases were more likely to occur between 00:00-06:00 and 18:00-00:00 and involved a higher proportion of non-helmeted riders (96.1% vs. 87.1%). Bicycle fatalities were more often due to collisions with automobiles (67.7%), while non-fatal injuries were mainly from crashes without a collision (45.8%). Head injuries were common in both groups, but traumatic brain injury (TBI) was significantly higher among cases (41.5% vs. 11.9%). Key factors associated with ED mortality included the time of injury, alcohol use, crashes on national highways, no helmet use, and collisions with automobiles. Helmet use was associated with a non-significant 35% lower risk of TBI and a significant 63% lower risk of ED mortality.

CONCLUSIONS

Key risk factors for fatal bicycle injuries included being aged 60-79, male, involved in nighttime crashes, collisions with automobiles, not wearing a helmet, and sustaining a traumatic brain injury (TBI). Helmet use was linked to lower rates of TBIs and reduced mortality. To decrease bicycle-related deaths, stronger legal regulations, educational efforts, and improved infrastructure are essential, along with further interventions and research to effectively tackle these issues.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Planning traffic surveillance in Spain: How to optimize the management of police resources to reduce road fatalities

Although traffic police enforcement is widely recognized as a key action in the road safety field, it can be a costly policy to implement. In addition, governments often impose budget constraints that can limit the resources available for activities such as law enforcement and surveillance. To evaluate the impact of human traffic control resources planning on traffic fatalities on Spanish NUTS-3 regions interurban roads, this paper uses an econometric model to investigate the performance of police enforcement intensity by focusing on two crucial traffic law infractions (i.e., speeding and drunk driving). After controlling for a range of economic, demographic, climate, and risk exposure variables, results highlight the relevance of visible, human, and in-person traffic law enforcement through regular vehicle patrols for reducing traffic crashes, with a non-significant effect of automatic enforcement. Our findings have important implications for traffic police resource management regarding the effective maintenance of patrol cars and plans to digitalize and automatize police administrative tasks and procedures.

An exploration of the role of driving experience on self-reported and real-world aberrant driving behaviors

A significant proportion of global road crashes are attributed to unsafe driving behaviors. The current study aimed to explore potential differences in driving behaviors across experienced and novice drivers using two separate approaches; a questionnaire study and an instrumented vehicle study (IVS). The analysis of 260 questionnaires and 1,372 traffic interactions within the IVS revelated that driving experience affects driving performance for different driving tasks. Factor analysis of the questionnaire data revealed the impact of driving errors, lapses, violations, and aggressive violations on the behavior of novice and experienced drivers. Behavioral models of novice and experienced drivers encountering other road users were determined using binary logistic regression. The results showed that novice drivers were more likely to engage in driving violations while experienced drivers were more likely to engage in aggressive violations. Unauthorized speeding, zigzag movements, using a mobile phone while driving, and unauthorized overtaking on roads were the most frequent driving violations by novice drivers. The most frequent aggressive violations by experienced drivers were tempting other drivers to create a race and chasing other drivers. These findings may be used as a framework to facilitate safer driving behaviors by reducing errors, lapses, violations and aggressive violations, and facilitating safety-promoting attitudes.

Modelling brake transition time of young alcohol-impaired drivers using hazard-based duration models

Braking performance of drivers is a crucial factor in evaluating the collision patterns and implementing road safety measures. Further, alcohol is known to impair driving control. The present study aims to examine the influence of a comprehensive range of Blood Alcohol Concentration (BAC) levels (0%, 0.03 %, 0.05 % and 0.08 %) on brake transition times of drivers. As young drivers show significantly higher crash risks compared to the experienced drivers, fifty-four young Indian drivers in the age group of 21-25 years (forty males and fourteen females) participated in the driving simulator experiments. The study adopted the framework of a within-subjects design, where each driver encountered rural and urban driving scenarios in a counterbalanced order, during experimental driving at each of the four BAC levels. Their brake transition times were estimated with respect to sudden pedestrian crossing events. Weibull Accelerated Failure Time (AFT) models with shared frailty were developed for quantifying the effects of BAC levels along with driver attributes on brake transition time. Preliminary analysis showed significant main effects of BAC (p < 0.001) and driving environment (p = 0.002) on brake transition time; however, their interaction effect was not significant (p = 0.485). The models revealed that 0.03 %, 0.05 % and 0.08 % BACs significantly reduced the brake transition times by 16 %, 28 % and 52 % in rural driving environment, and by 23 %, 37 % and 53 % in urban driving environment, compared to 0% BAC. The study outcomes may find application in assisting collision warning systems which take into account the braking behaviour of drivers.

Mid-term prediction of at-fault crash driver frequency using fusion deep learning with city-level traffic violation data

Traffic violations and improper driving are behaviors that primarily contribute to traffic crashes. This study aimed to develop effective approaches for predicting at-fault crash driver frequency using only city-level traffic enforcement predictors. A fusion deep learning approach combining a convolution neural network (CNN) and gated recurrent units (GRU) was developed to compare predictive performance with one econometric approach, two machine learning approaches, and another deep learning approach. The performance comparison was conducted for (1) at-fault crash driver frequency prediction tasks and (2) city-level crash risk prediction tasks. The proposed CNN-GRU achieved remarkable prediction accuracy and outperformed other approaches, while the other approaches also exhibited excellent performances. The results suggest that effective prediction approaches and appropriate traffic safety measures can be developed by considering both crash frequency and crash risk prediction tasks. In addition, the accumulated local effects (ALE) plot was utilized to investigate the contribution of each traffic enforcement activity on traffic safety in a scenario of multicollinearity among predictors. The ALE plot illustrated a complex nonlinear relationship between traffic enforcement predictors and the response variable. These findings can facilitate the development of traffic safety measures and serve as a good foundation for further investigations and utilization of traffic violation data.

A crash risk identification method for freeway segments with horizontal curvature based on real-time vehicle kinetic response

With the development and maturation of vehicle-based data acquisition technology, in-vehicle data is increasingly being used to explore road safety. This paper reports on research that analyzed the real-time tire force data (kinetic response) obtained from vehicle kinetic experiments, and constructed a new approach for identifying the high-risk of crashes on freeway segments with horizontal curvature. First, the road was divided into 1km units. Then, taking into account the characteristics of freeway alignment, each segment with horizontal curve was selected as the object of subsequent analysis. Automotive instrumentation was used to obtain a measure of tire force in the course of normal driving. The entire data set was preprocessed according to rate of change and the density of the data was reduced. By defining the outliers of the kinetic data and conducting factor analysis, two representative crash risk indicators of longitudinal and lateral stability were obtained. Negative binomial regression model (NBR model) and random effects negative binomial regression model (RENBR model) were constructed and jointly applied based on the new indicators to predict the risk value of horizontal curve segments. The method showed good prediction performance (71.8 %) for high-risk road segments with design flaws, but the predicted effect for low-risk road segments was not ideal. This study not only illustrated the effectiveness of in-vehicle data in assessing road crash risk by coupling multiple kinetic parameters, but also provided support for freeway safety research using surrogate measures of risk when there is a lack of crash statistics.

Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

Modelling braking behaviour and accident probability of drivers under increasing time pressure conditions

Drivers apply brakes to reduce the speed of a vehicle based on the perceived risk while approaching a certain event. Inadequate or excessive braking can lead to serious consequences. The current study analyses the braking behaviour and accident probability of the drivers under increasing time pressure conditions. Two perilous events (pedestrian crossing and obstacle overtaking) were designed to examine Brake Pedal Force (BPF) and Brake-To-Maximum Brake (BTMB) transition time on a driving simulator. Eighty-five Indian licensed drivers drove the simulator in three different time pressure conditions: No Time Pressure (NTP) (baseline), Low Time Pressure (LTP), and High Time Pressure (HTP). Random parameters Tobit model was used for analysing BPF and duration analysis approach was considered for BTMB analysis. Further, generalized linear mixed model with logit link function was used to study the effect of BPF and BTMB on accident probability of the drivers. The model results showed that gender, driving profession, approach speed, age, driving history, and driving condition significantly affected braking behaviour of the drivers. It was observed that in pedestrian crossing event, LTP and HTP driving conditions resulted in 42.31 % and 87.28 % increase in BPF and 13 % and 23 % reduction in BTMB respectively with respect to NTP driving condition and the corresponding changes were slightly lower in case of obstacle overtaking event. The accident probability model showed that female drivers needed 119.70 % and 186.08 % more BPF and 37.55 % and 58.51 % less BTMB in LTP and HTP driving conditions respectively to have equivalent risk levels as observed for male drivers. Further, non-professional drivers had to increase their BPF by 166.83 % in LTP and 219.93 % in HTP to offset their increased accident risk as compared to professional drivers under time pressure conditions.

RETRACTED ARTICLE: Psychological predictors behind the intention to drink and drive among female drivers: Application of extended theory of planned behavior

We, the Editor and Publisher of Traffic Injury Prevention, have retracted the following article:Ankit Kumar Yadav. Psychological predictors behind the intention to drink and drive among female drivers: Application of extended theory of planned behavior. Traffic Injury Prevention. 2020. https://doi.org/10.1080/15389588.2019.1703961.The author has requested the retraction of his article due to an error in one of the collected psychological measures. During data extraction, the responses for 'attitude' and 'intention' measures were switched and may have influenced the findings from the developed regression model and its results. As a result, the Editor and Publisher have agreed to retract the article in full.We have investigated and have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as "Retracted".

Incidence of Mild Traumatic Brain Injury: A Prospective Hospital, Emergency Room and General Practitioner-Based Study

Background: There are no recent estimates of incidence rates of mild traumatic brain injury (MTBI) from Norway. Moreover, reported incidence rates rarely comprise cases of MTBI evaluated in the primary care setting. In this study, we utilized existing data collected as part of the recruitment to a large, follow-up study of patients with MTBI. We estimated the incidence rate of MTBI, including patients who visited outpatient clinics, in the age group 16–59 years in a Norwegian region.

Methods: During 81 weeks in 2014 and 2015, all persons aged 16–59 years, presenting with possible MTBI to the emergency department (ED) at St. Olavs Hospital, Trondheim University Hospital or to the general practitioner (GP)-run Trondheim municipal outpatient ED, were evaluated for a diagnosis of MTBI. Patients were identified by computerized tomography (CT) referrals and patient lists. Patients referred to acute CT from their primary GP with suspicion of MTBI were also recorded. This approach identified 732 patients with MTBI. Age- and sex-specific incidence rates of MTBI were calculated using population figures from the regional catchment area.

Results: Overall incidence of MTBI in people between 16 and 59 years was 302 per 100,000 person-years (95% confidence interval 281–324). The incidence rate was highest in the age group 16–20 years, where rates were 835 per 100,000 person-years in males and 726 in females.

Conclusion: The overall incidence rate of MTBI was lower than expected from existing estimates. Like other reports, the incidence was highest in the late teens.

Effect of alcohol use on accelerating and braking behaviors of drivers

Objective: The present study examines the accelerating and braking behaviors of drivers at different blood alcohol concentrations (BACs) in heterogeneous driving conditions using driving simulator experiments. Methods: Eighty-two licensed drivers performed simulated driving in a rural road environment designed in the driving simulator at 4 BAC levels: 0.00, 0.03, 0.05, and 0.08%. Driving performance was analyzed using vehicle control variables such as mean acceleration and mean brake pedal force. Generalized linear mixed models were developed to quantify the effect of different alcohol levels and explanatory variables such as driver's age, gender, and other factors on the driving performance indicators. Results: Alcohol use was reported as a significant factor affecting the accelerating and braking performance of drivers. The acceleration model results indicated that drivers' mean acceleration increased by 0.013, 0.026, and 0.027 m/s² for BAC levels of 0.03, 0.05, and 0.08%, respectively. Results of the brake pedal force model showed that drivers' mean brake pedal force increased by 1.09, 1.32, and 1.44 N for BAC levels of 0.03, 0.05, and 0.08%, respectively. Age was a significant factor in both the models where a 1-year increase in driver age resulted in a 0.2% reduction in mean acceleration and a 19% reduction in mean brake pedal force. Driving experience could compensate for the negative effects of alcohol to some extent while driving. Conclusions: The findings of the present study revealed that drivers tend to be more aggressive and impulsive under the influence of alcohol, which deteriorates their driving performance. Impairment in accelerating and braking behaviors of drivers under the influence of alcohol leads to increased crash probabilities. The conclusions may provide reference in making countermeasures against drinking and driving and contribute to traffic safety.

A trauma registry experience from the main referral center of Honduras: A call for action

BACKGROUND

Honduras is one of the most violent countries in the world and it has limited epidemiological data that describes the extent of intentional and unintentional injuries. This research is needed to develop and inform prevention programs in Honduras, as well as to spread international awareness.

METHODS

A cross-sectional study was carried out on a paper-based injury surveillance system (InSS) with the help of Honduras' University Medical School Hospital (UMSH), the main referral medical center in Tegucigalpa-Honduras. Descriptive statistics and bivariate analysis were carried out using data from all registered injuries in 2013.

RESULTS

Of the 17,971 injuries reported, intentional injuries made up 18.14% of all injuries. Interpersonal violence from gun violence, robberies, and physical altercations accounted for 14.68%. Self-inflicted injuries made up 3.46% of injuries, with suicide falls and poison intoxications being the most frequent (1.9% and 1.2%, respectively). Sexual harassment was minimally reported (0.27%, n = 48). Unintentional injuries made up 81.79% of the total injuries. The most common causes of unintentional injuries were falls (38.01%) and road traffic injuries (16.65%). Motorocyclists made up 35.4% of those injured by road traffic accidents. In general, injuries occured during the weekend and mainly affected men during the ages when they would be most likely to work and maintain jobs. The modified Kampala trauma score (M-KTS) showed that most of the injuries were mild (range 3-11), with 59.59% of the patients with a M-KTS of 9, and an overall mortality rate of 0.65% (n = 117).

CONCLUSION

The description of injuries provides the basis for prevention. The disproportionate number of unintentional injuries (4:1) seen in Honduras' referral hospital calls for further research in: 1) trauma care logistics and emergency systems, 2) mortality and lethality of intentional injuries, and 3) analysis of the types of unintentional injuries. Further research is necessary to evaluate interventions and identify the socioeconomic effects of injuries in the region.

Impacts of helmet law on the changes in potential years of life lost due to traffic injury: a multiple-province evaluation in Vietnam

INTRODUCTION

This study aimed to evaluate the impact of the helmet law on the changes in potential years of life lost (PYLL) due to traffic mortality and to examine modification effects of socioeconomic factors on the impacts in Vietnam.

METHODS

We applied an interrupted time series design using the Bayesian framework to estimate the impact of the law at the provincial level. Then, we used random effects meta-analysis to estimate the impact of the law at the country level and to examine the modification effects of socioeconomic factors.

RESULTS

The results indicate that the impacts varied among the provinces. These impacts could be classified by four main groups comprising positive impact, and positive impact without sustainability, possible positive impact, negative or inconsistent impact. For the country-level impact, the results reveal a significantly consistent change in monthly PYLLs at the level of 18 per 100 000 persons, and the post-trend was stable without significant change. The results of meta-regression show that 1 unit increase in the population density (persons/km²), migration rate (%) and income (×1000 dong) are non-significantly associated with increases of PYLLs at 1.3, 27 and 27 per 100 000 person-months, respectively, whereas 1% increase in literacy associated with a decrease of PYLL at 44 per 100 000 person-months.

DISCUSSION

Further studies should be warranted to provide a comprehensive evaluation of the law implementation, including its acceptability, adoption, appropriateness, feasibility, cost-effectiveness and sustainability.

Safety seat and seat belt use among child motor vehicle occupants, Cluj-Napoca, Romania

BACKGROUND

Use of seat belts and car seats for children are among the most effective interventions to reduce injury severity when a crash occurs. The use should be enforced in order to have an increase in wearing these restraints. Romania has the lowest rate of using seatbelts in the backseat, 16%. The purpose of the study is to describe the use of child safety restraints and compare it with existing standards of good practice.

METHODS

An observational study on child safety restraint was conducted in Cluj-Napoca, Romania, between 2013 and 2014. Observational sites included 38 schools and kindergartens and three commercial areas, where drivers (n=768) and child passengers (n=892) were observed. Observations were conducted as vehicles parked or pulled to a stop and were followed by driver surveys on knowledge and attitudes towards restraint legislation and child safety behaviour as car occupants.

RESULTS

The proportion of observed child motor vehicle occupants wearing some type of restraint was 67.4% (n=601). The majority of children (82.6%) were in the back seat, and 14.2% of infants were in a rear-facing child seat. The proportion of restrained children declined with age, with children 5 years old or younger being almost five times more likely to be properly restrained (OR 4.87, 95% CI 2.93 to 8.07) when compared with older children.

CONCLUSIONS

Although minimum legal requirements of child motor vehicle occupant safety were in place in Romania at the time of the study, the rates of using children restraints was low compared with other middle-income and high-income countries.

Effects of texting on accident risk during a sudden hazardous event: Analysis of predetection and postdetection phases

OBJECTIVE

The present study aims to quantify the effects of texting and driver behavior on the accident risk associated with a sudden event. Further, the study attempts to compare the effects of driving behavior of inexperienced young and professional drivers on risk during predetection and postdetection phases of the event.

METHODS

Forty-nine drivers from 2 categories-inexperienced young drivers and experienced professional drivers-took part in simulated experiments. The participants drove in a free-flow road environment under 3 driving conditions: no distraction (baseline) and writing short and long texts while driving. The participants were exposed to a sudden hazardous event during each drive. Accident probability during the sudden event was modeled with a generalized linear mixed model (with a logit link function).

RESULTS

As expected, both texting tasks increased accident risk, and the risk was much higher for inexperienced young drivers than for professional drivers. Time lapsed in reducing speed increased the odds for accident risk significantly. A comparative analysis of the driver categories showed that impairment in driving behavior due to the texting tasks was similar for both groups during the predetection phase. However, the risk associated with the texting tasks was higher for young drivers during the postdetection phase. A possible reason could be that young drivers had 65% and 75% higher approach speeds (than the professional drivers) during the short and long text tasks, respectively.

CONCLUSIONS

The results provide statistical evidence that increased speed is expressed as increased risk-taking behavior among young drivers, which subsequently is the main reason for their higher accident risk during texting tasks. Moreover, the results confirm that professional drivers are not able to mitigate the increased accident risk associated with texting tasks due to late detection of the event during the tasks.

Associations between active travel and physical multi-morbidity in six low- and middle-income countries among community-dwelling older adults: A cross-sectional study

BACKGROUND

There is little evidence on the potential health benefits of active travel in low- and middle-income countries (LMICs). The aim of this study was to assess the association between levels of active travel and physical multi-morbidity (i.e., two or more chronic physical conditions) and individual physical conditions among community-dwelling adults aged 65 or older in six LMICs.

METHODS

Data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa). Active travel (minutes / week) was assessed with questions of the Global Physical Activity Questionnaire (GPAQ) and presented in tertiles. Eleven chronic conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed by self-report of diagnosis, symptoms, or blood pressure measurement. Multivariable logistic regression analysis was conducted to assess the association between levels of active travel, physical conditions and physical multi-morbidity.

RESULTS

The final sample consisted of 14,585 individuals aged ≥65 years (mean age = 72.6±0.1 years; 54.9% female). In the fully adjusted model, compared to the highest tertile, those in the lowest tertile of active travel had a 1.28 (95%CI = 1.06-1.54) times higher odds for physical multi-morbidity. The association between active travel and physical multi-morbidity was significantly mediated by affect (14.4%) and cognition (9.7%). With regard to individual conditions, hearing problems, hypertension, stroke, and visual impairment were particularly strongly associated with less active travel.

CONCLUSION

The current data suggest that lower levels of active travel are associated with the presence of physical health conditions and physical multi-morbidity. This multi-national study offers potentially valuable insight for a number of hypotheses which may influence this relationship, although testing with longitudinal studies is needed.

The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia

BACKGROUND

Because Saudi Arabia (SA) has struggled with the burden of Road Traffic Injuries (RTIs) for decades, a new automated citations system was implemented in 2018 to improve compliance with seatbelt and mobile phone laws. Therefore, the purpose of this study is to evaluate the impact of the system on the prevalence of seatbelt and mobile phone use among drivers in Riyadh. This is an observational study conducted between 2017 and 2018. A Pre-Post evaluation was employed to determine the impact of a camera detection system on seatbelt and mobile phone use. Two research coordinators collected the observations at several highways and inner intersections around Riyadh (n = 3400). We evaluated differences in the prevalence of seatbelt and mobile phone use across the two time periods using a chi-2 test. In addition, we evaluated the association between the new intervention and traffic violation using a logistic regression model.

RESULTS

The overall seatbelt compliance increased significantly from 33.9% (95% CI = 31.7-36.2) to 75.8% (95% CI = 73.7-77.8; P < 0.01). In addition, mobile phone use declined significantly from 13.8% (95% CI = 12.2-15.5) to 9.8 (95% CI = 8.8-9.1; P < 0.01). We found the detection system to be associated with a significant increase in seatbelt use and also a significant decline in mobile phone use while driving. After implementing the intervention, drivers were 6.1 times (OR = 6.1, 95% CI = 5.2-7.0) more likely to wear seatbelts than before the technology went into effect. Similarly, drivers observed after implementing the cameras were 32% (OR = 0.68, 95% CI = 0.55,0.84) less likely to use mobile phones while driving than those seen prior to the intervention.

CONCLUSIONS

This study found a significant reduction in traffic violations following the implementation of a camera detection system in Riyadh. This positive impact is evidence for the role preventative structural strategies play to improve traffic safety and reduce RTI in SA. Therefore, these findings may facilitate further support for policymakers that public health interventions play a significant role to improve traffic safety. Seatbelt and mobile phone use while driving should continue to be monitored, and traffic police may evaluate whether increasing the fine is associated with a significant reduction in traffic violations and associated crashes.

Burden of road traffic injuries related to delays in implementing safety belt laws in low- and lower-middle-income countries

OBJECTIVE

Delayed implementation of effective road safety policies must be considered when quantifying the avoidable part of the fatal and nonfatal injuries burden. We sought to assess the avoidable part of disability-adjusted life years (DALYs) lost due to road traffic injuries related to delays in implementing road safety laws in low- and lower-middle-income countries.

METHODS

We chose one country for each of the regions of the World Health Organization (WHO) and World Bank (WB) country income levels. We used freely available data sets (WHO, International Traffic Safety Data and Analysis Group, the WB). Delays in implementation were calculated until 2013, from the year mandatory use of safety belts by motor vehicle front seat occupants was first introduced worldwide. We used life expectancy tables and age groups as social values in the DALY calculation model. From the estimated total burden, avoidable DALYs were calculated using estimates of the effectiveness of seat belt laws on fatal and nonfatal injuries combined, as extracted from published international reviews of evidence.

RESULTS

From the reference year 1972, implementation delays varied from 27 years (Uzbekistan) to 41 years in Bolivia (no seat belt law as of 2013). During delays, total absolute numbers of DALYs lost due to road traffic injuries reached 8,462,099 in Nigeria, 7,203,570 in Morocco, 4,695,500 in Uzbekistan, 3,866,391 in Cambodia, 3,253,359 in Bolivia, and 3,128,721 in Sri Lanka. Using effectiveness estimates ranging from 3 to 20% reduction, the avoidable burden of road traffic injuries for car occupants was highest in Uzbekistan (avoidable part from 1.2 to 10.4%) and in Morocco (avoidable part from 1.5 to 12.3%). In countries where users of public transport and pedestrians were the most affected by the burden, the avoidable parts ranged from 0.5 to 4.4% (Nigeria) and from 0.5 to 3.4% (Bolivia). Burden of road traffic injuries mostly affected motorcyclists in Sri Lanka and Cambodia where the avoidable parts were less than 2% in both countries. In all selected countries, burden of traffic injuries mostly affected men (about 80%) as well as young people (15-34 years).

CONCLUSIONS

Despite limited data availability in low- and middle-income countries, the avoidable part of the burden related to delayed intervention is measurable. These results can be used to convince countries to avoid delaying the provision of better protection to road users.

Mobile phone use during driving: Effects on speed and effectiveness of driver compensatory behaviour

This study analysed and modelled the effects of conversation and texting (each with two difficulty levels) on driving performance of Indian drivers in terms of their mean speed and accident avoiding abilities; and further explored the relationship between speed reduction strategy of the drivers and their corresponding accident frequency. 100 drivers of three different age groups (young, mid-age and old-age) participated in the simulator study. Two sudden events of Indian context: unexpected crossing of pedestrians and joining of parked vehicles from road side, were simulated for estimating the accident probabilities. Generalized linear mixed models approach was used for developing linear regression models for mean speed and binary logistic regression models for accident probability. The results of the models showed that the drivers significantly compensated the increased workload by reducing their mean speed by 2.62m/s and 5.29m/s in the presence of conversation and texting tasks respectively. The logistic models for accident probabilities showed that the accident probabilities increased by 3 and 4 times respectively when the drivers were conversing or texting on a phone during driving. Further, the relationship between the speed reduction patterns and their corresponding accident frequencies showed that all the drivers compensated differently; but, among all the drivers, only few drivers, who compensated by reducing the speed by 30% or more, were able to fully offset the increased accident risk associated with the phone use.

Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia

BACKGROUND

Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia.

OBJECTIVE

To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system.

DESIGN

Retrospective, analytical.

SETTING

Trauma center of a tertiary care center in Riyadh.

PATIENTS AND METHODS

The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods.

MAIN OUTCOME MEASURE(S)

Injury severity score (ISS), Glasgow coma scale (GCS) and mortality.

RESULTS

The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (-3.1, 95% CI -4.6, -1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant.

CONCLUSIONS

This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs.

LIMITATIONS

The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.